Program of Study Change Request

1). Please complete all sections of this form, even if the information is not changing
2). Notify your current program that you are requesting to change your program of study
3). Submit form electronically no less than two weeks prior to your desired start quarter for processing
4). Students may request letters of recommendation required to apply to their current program be sent to the Radiation & Imaging Sciences program electronically at rais@bellevuecollege.edu
5). Due to the varying personal statement prompts, all students must complete and submit a new personal statement
Name
First Last
BC Student ID (SID)
BC Student Email
We will communicate with you using your BC student email.
Phone

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Program You are Currently Enrolled In
RAIS Program You are Applying For
Concentration You are Applying For
Desired Start Quarter
To assist our advising, please indicate which quarter you plan on attending the program for which you are applying.
Are you interested in completing a clinical practicum?
- Yes
- No
- Unsure
Certificate Program You are Applying For
Please choose the certificate program you would like to apply for. Students wishing to apply for multiple certificate programs will be required to apply for each program individually.
Desired Clinical Modality
Please choose the clinical modality you would like to complete.
Desired Clinical City or Region

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The Radiation & Imaging Sciences program is designed for certified professionals in radiologic technology, diagnostic ultrasound, radiation therapy, or nuclear medicine who hold an associate degree from a regionally-accredited college radiologic technology, diagnostic ultrasound, radiation therapy, or nuclear medicine, and who hold primary certification in one of those fields or are anticipating completion of their certification.
Do you currently have a National Certification?
Certifying Organization
(i.e. RCIS, ARRT, etc.)
Anticipated Certificate Completion Date
MM slash DD slash YYYY

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In order to expedite the review of your application for selective admission to this program, please provide unofficial transcripts from each school attended. You do not need to upload unofficial transcripts from Bellevue College.
You will also be required to provide official transcripts from all schools attended if you have not already done so with your current program. You may request all official transcripts on file with your current program be forwarded to the Radiation & Imaging Sciences program electronically at rais@bellevuecollege.edu
Unofficial Transcripts
Please upload a copy of your unofficial transcripts from all colleges other than Bellevue College that you have attended. File must not exceed 128MB.
Max. file size: 5 MB.
Additional Unofficial Transcripts
Please upload a copy of any additional unofficial transcripts from colleges, other than Bellevue College, you have attended. If no additional school have been attended, please leave blank. File must not exceed 128MB.
Max. file size: 5 MB.
Additional Unofficial Transcripts
Please upload a copy of any additional unofficial transcripts from colleges, other than Bellevue College, you have attended. If no additional school have been attended, please leave blank. File must not exceed 128MB.
Max. file size: 5 MB.
If you completed any coursework at a school other than Bellevue College while enrolled in your current program, please send all official transcripts to our offices at
Bellevue College
ATTN: Radiation and Imaging Sciences
3000 Landerholm Circle SE, #T208
Bellevue, WA 98007

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All supporting documents are required to complete your request.
Students may request letters of recommendation required to apply to their current program be sent to the Radiation & Imaging Sciences program electronically at rais@bellevuecollege.edu.
Due to the varying personal statement prompts, all students must complete and submit a new personal statement.
Personal Statement Upload
Please give us a personal statement (no more than 500 words) discussing your work experience; your personal and professional goals; advanced certifications you already possess; any specific or unique attributes that you will bring to the program; any challenges or hardships you have overcome in pursuing your educational or work goals; or any other special considerations that you believe will make you a good candidate for the program. Allowed file types are pdf, txt, doc, and docx
Max. file size: 5 MB.
Please have two letters of recommendation, on company letterhead, from someone who personally knows your work, such as your current or past supervisor, discussing your contributions to your work place and how they believe you will benefit from completion of this BAS program. If you are applying for this program immediately after completing an associate degree program, the letters of recommendation may be from your instructors on college letterhead.

Have reference letters sent to:
Radiation & Imaging Sciences
Bellevue College
ATTN: Radiation & Imaging Sciences
3000 Landerholm Circle SE, #T208
Bellevue, WA 98007

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Your signature below indicates that you understand that you
1) authorize changes to your program of study, if accepted to your desired program
2) understand that changing you major and/or degree type may impact you eligibility for Federal subsidized loan funding and should contact my Financial Aid Counselor before making the change to see if your loan eligibility will be impacted.
3) understand that changing your program will officially change your degree worksheet to the most current degree worksheet for your desired degree
Type your full name to Electronically Sign*
I understand that typing my name constitutes a legal signature, and hereby confirm that I warrant the truthfulness of the information provided in this application.
Comments
This field is for validation purposes and should be left unchanged.

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Program of Study Change Request

Program of Study Change Request

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