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BioData Form

Please complete the information below or submit a resume or vita.

Name:

Telephone #s

:

home #

Address:

work #

cell #

E-mail:

Education:

Institution

Degree/Certificate Received

Area of Study

Employment History:

Organization

Dates

Job Title

1.

2.

3.

4.

Professional Affiliations, Licensures, & Certificates:

List all relevant to radiologic technology.

Other:

awards, service, special interests

Optional Summary Statement:

Highlight strongest skills and area of professional expertise

Thank you! Please return this form along with the ARRT Exam Development Activity

Preference Form via: fax (651) 681-3298; or mail to ARRT, Attn: Psychometric Services, 1255

Northland Dr., St. Paul, MN 55120

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