CT Applicant Information

CT Applicant Information

Eastern North Carolina Consortium of Computed Tomography & Magnetic Resonance Imaging

Step 1 of 2

First Name*
Middle Initial
Last Name*
ECC Student ID Number*
Gender*
- Male
- Female
Date of Birth*
Email Address*
Enter Email Confirm Email
Street Address*
City*
State*
Zip Code*
Primary Phone*
Alternate Phone 1
Alternate Phone 2
College Experience*
School Degree Earned Graduation Date

If you have earned more than one degree, select (+) after Graduation Date field. If you have no college experience, enter N/A for each field and proceed to the next section.

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