{"id":2015,"date":"2019-03-29T13:56:15","date_gmt":"2019-03-29T17:56:15","guid":{"rendered":"http:\/\/sw.edu\/health-technology\/?page_id=2015"},"modified":"2023-07-27T12:58:26","modified_gmt":"2023-07-27T12:58:26","slug":"computed-tomography-application","status":"publish","type":"page","link":"https:\/\/sw.edu\/health-technology\/computed-tomography-application\/","title":{"rendered":"Computed Tomography Application"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_22'>Phone<\/label><div class='ginput_container'><input name='input_22' id='input_4_22' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_4_22'>This field is for validation purposes and should be left unchanged.<\/div><\/div><fieldset id=\"field_4_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_4_1'>\n                            \n                            <span id='input_4_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_4_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_4_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_4_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_4_2\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_4_2' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_2_1_container' >\n                                        <input type='text' name='input_2.1' id='input_4_2_1' value=''    aria-required='true'    \/>\n                                        <label for='input_4_2_1' id='input_4_2_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_4_2_2_container' >\n                                        <input type='text' name='input_2.2' id='input_4_2_2' value=''     aria-required='false'   \/>\n                                        <label for='input_4_2_2' id='input_4_2_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_2_3_container' >\n                                    <input type='text' name='input_2.3' id='input_4_2_3' value=''    aria-required='true'    \/>\n                                    <label for='input_4_2_3' id='input_4_2_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_4_2_4_container' >\n                                        <select name='input_2.4' id='input_4_2_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' selected='selected'>Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_4_2_4' id='input_4_2_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_4_2_5_container' >\n                                    <input type='text' name='input_2.5' id='input_4_2_5' value=''    aria-required='true'    \/>\n                                    <label for='input_4_2_5' id='input_4_2_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_2.6' id='input_4_2_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_3\" class=\"gfield gfield--type-phone gfield--input-type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_3'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_4_3' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_4\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_4_4_container'>\n                                <span id='input_4_4_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_4' id='input_4_4' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_4_4' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_4_4_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_4_2' id='input_4_4_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_4_4_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_4_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_5'>EmplID<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_4_5' type='text' value='' class='medium'  aria-describedby=\"gfield_description_4_5\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_4_5'>Assigned upon completion of SWCC Admission Application<\/div><\/div><fieldset id=\"field_4_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you ARRT Registered in Radiography or currently finishing an accredited Radiography, Radiation Therapy, or Nuclear Medicine program?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_6'>\n\t\t\t<div class='gchoice gchoice_4_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Yes'  id='choice_4_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_6_0' id='label_4_6_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='No'  id='choice_4_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_6_1' id='label_4_6_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Select which college you will be attending<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_20'>\n\t\t\t<div class='gchoice gchoice_4_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='SWCC'  id='choice_4_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_20_0' id='label_4_20_0' class='gform-field-label gform-field-label--type-inline'>Southwest Virginia Community College<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='VHCC'  id='choice_4_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_20_1' id='label_4_20_1' class='gform-field-label gform-field-label--type-inline'>Virginia Highlands Community College<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you completed an Admission Application to become a student at SWCC or VHCC?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_7'>\n\t\t\t<div class='gchoice gchoice_4_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Yes'  id='choice_4_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_0' id='label_4_7_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='No'  id='choice_4_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_1' id='label_4_7_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='I am already ARRT Registered in Radiography or currently finishing an accredited Radiography program'  id='choice_4_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_2' id='label_4_7_2' class='gform-field-label gform-field-label--type-inline'>I am already ARRT Registered in Radiography or currently finishing an accredited Radiography program<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_8\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_8'>College where you completed (or plan to complete) your Radiography, Radiation Therapy, or Nuclear Medicine degree?<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_4_8' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_9\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_9'>Graduation Year<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_4_9' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_10\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_10'>Upload your ARRT or CNMT certification or current unofficial transcript of Radiography, Radiation Therapy, or Nuclear Medicine curriculum if not registered<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='73728000' \/><input name='input_10' id='input_4_10' type='file' class='medium' aria-describedby=\"gfield_upload_rules_4_10\" onchange='javascript:gformValidateFileSize( this, 73728000 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_4_10'>Accepted file types: jpg, gif, png, pdf, Max. file size: 70 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_4_10'><\/div> <\/div><\/div><div id=\"field_4_15\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_15'>Upload your PPD TB Skin Test and Shot Records (To include if available:  MMR, Varicella, Hep B)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='73728000' \/><input name='input_15' id='input_4_15' type='file' class='medium' aria-describedby=\"gfield_upload_rules_4_15\" onchange='javascript:gformValidateFileSize( this, 73728000 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_4_15'>Max. file size: 70 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_4_15'><\/div> <\/div><\/div><div id=\"field_4_11\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_11'>Upload your current American Heart Association CPR card<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='73728000' \/><input name='input_11' id='input_4_11' type='file' class='medium' aria-describedby=\"gfield_upload_rules_4_11\" onchange='javascript:gformValidateFileSize( this, 73728000 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_4_11'>Max. file size: 70 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_4_11'><\/div> <\/div><\/div><fieldset id=\"field_4_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Select your preferred clinical site placement (Due to site limitations there are no guarantees)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_12'>\n\t\t\t<div class='gchoice gchoice_4_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Bristol Regional Medical Center, Bristol, TN'  id='choice_4_12_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_4_12\"   \/>\n\t\t\t\t\t<label for='choice_4_12_0' id='label_4_12_0' class='gform-field-label gform-field-label--type-inline'>Bristol Regional Medical Center, Bristol, TN<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Buchanan General Hospital, Grundy, VA'  id='choice_4_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_1' id='label_4_12_1' class='gform-field-label gform-field-label--type-inline'>Buchanan General Hospital, Grundy, VA<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Carilion Clinic Riverside'  id='choice_4_12_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_2' id='label_4_12_2' class='gform-field-label gform-field-label--type-inline'>Carilion Clinic Riverside<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Carillon New River Valley Medical Center'  id='choice_4_12_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_3' id='label_4_12_3' class='gform-field-label gform-field-label--type-inline'>Carillon New River Valley Medical Center<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Carillon Clinic, Roanoke, VA'  id='choice_4_12_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_4' id='label_4_12_4' class='gform-field-label gform-field-label--type-inline'>Carillon Clinic, Roanoke, VA<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Clinch Valley Medical Center, Richlands, VA'  id='choice_4_12_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_5' id='label_4_12_5' class='gform-field-label gform-field-label--type-inline'>Clinch Valley Medical Center, Richlands, VA<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Giles Memorial Hospital, Pearisburg, VA'  id='choice_4_12_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_6' id='label_4_12_6' class='gform-field-label gform-field-label--type-inline'>Giles Memorial Hospital, Pearisburg, VA<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Holston Valley Medical Center'  id='choice_4_12_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_7' id='label_4_12_7' class='gform-field-label gform-field-label--type-inline'>Holston Valley Medical Center<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Johnston Memorial Hospital, Abingdon, VA'  id='choice_4_12_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_8' id='label_4_12_8' class='gform-field-label gform-field-label--type-inline'>Johnston Memorial Hospital, Abingdon, VA<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Lewis Gale Pulaski Community Hospital, Pulaski, VA'  id='choice_4_12_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_9' id='label_4_12_9' class='gform-field-label gform-field-label--type-inline'>Lewis Gale Pulaski Community Hospital, Pulaski, VA<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Smyth County Community Hospital, Marion, VA'  id='choice_4_12_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_10' id='label_4_12_10' class='gform-field-label gform-field-label--type-inline'>Smyth County Community Hospital, Marion, VA<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Twin County Regional Hospital, Wytheville, VA'  id='choice_4_12_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_11' id='label_4_12_11' class='gform-field-label gform-field-label--type-inline'>Twin County Regional Hospital, Wytheville, VA<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Wythe County Hospital'  id='choice_4_12_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_12' id='label_4_12_12' class='gform-field-label gform-field-label--type-inline'>Wythe County Hospital<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_13'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Do not wish to complete clinical rotations. *(Without clinical competencies, the student is ineligible to apply to sit for ARRT Registry examination.)'  id='choice_4_12_13' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_13' id='label_4_12_13' class='gform-field-label gform-field-label--type-inline'>Do not wish to complete clinical rotations. *(Without clinical competencies, the student is ineligible to apply to sit for ARRT Registry examination.)<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_4_12'>Please note that some clinical sites are requiring Covid vaccination.\n<\/div><\/fieldset><div id=\"field_4_16\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><strong>Acknowledgement of Reciprocity Statement: Pursuant to United States Department of Education (US DOE) regulation 34 CFR 668.43 (a) (5) (v), the Southwest Virginia Community College Career Studies Certificate in Computed Tomography program provides the following information for all prospective and current students: <\/strong>\n<ul><li>This program prepares students to sit for professional exams and\/or apply for professional licensure that is required for employment in the related occupation in Virginia. If you live or move outside of Virginia, you must consult with the program lead to confirm whether the program will meet your state\u2019s requirements prior to enrolling in courses. <\/li><\/ul><\/div><fieldset id=\"field_4_19\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_19.1' id='input_4_19_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_4_19_1' >I understand the Computed Tomography Program Reciprocity Statement above.<\/label><input type='hidden' name='input_19.2' value='I understand the Computed Tomography Program Reciprocity Statement above.' class='gform_hidden' \/><input type='hidden' name='input_19.3' value='3' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_4_17\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Students must be ARRT or CNMT registered before fall semester begins or they are ineligible for clinical rotations. <\/div><div id=\"field_4_21\" class=\"gfield gfield--type-captcha gfield--input-type-captcha field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_21'>CAPTCHA<\/label><div id='input_4_21' 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