Health Careers Application

Anticipated Enrollment * Spring 2026 Fall 2026

Please note that you are only able to apply to two programs.

Primary Program * Certified Medical Assistant Certificate (Fall 2026 Only) Diagnostic Medical Sonography Degree (Fall 2026 Only) Diagnostic Medical Sonography Certificate (MUST be Current Radiology and/or Nuclear Med Tech) (Fall 2026 Only) Ophthalmic Technology Degree (Fall 2026 Only) Radiologic Technology Degree (Fall 2026 Only) Respiratory Care Degree (Fall 2026 Only) Sterile Processing Technician Certificate (Fall 2026 Only) Surgical Technology Degree (Fall 2026 Only)

Secondary Program (If Applicable) Certified Medical Assistant Certificate (Fall 2026 Only) Diagnostic Medical Sonography Degree (Fall 2026 Only) Diagnostic Medical Sonography Certificate (MUST be Current Radiology and/or Nuclear Med Tech) (Fall 2026 Only) Ophthalmic Technology Degree (Fall 2026 Only) Radiologic Technology Degree (Fall 2026 Only) Respiratory Care Degree (Fall 2026 Only) Sterile Processing Technician Certificate (Fall 2026 Only) Surgical Technology Degree (Fall 2026 Only)

First Name *

Middle Name or Initial

Last Name *

Colleague ID Number (7 Digit Number) *

Address *

Apartment/Unit

City *

State *

Zip Code *

Primary Phone *

Secondary Phone

Last 4 digits of Social Security Number *

Birthdate *

NOTE: Triton College’s official form of communication is through the Triton email address assigned to each student.

Triton Email *

Secondary Email

Gender * Male Female Prefer not to Answer Self-Describe (See Below)

Self-Describe Gender (if Applicable)

Ethnicity * Hispanic or Latino/a/x Not Hispanic or Latino/a/x Prefer Not to Answer

Race * (Select All that Apply) Asian Middle Eastern or North African Native Hawaiian or another Pacific Islander White Black or African American American Indian or Alaska Native Two or More Races Prefer Not to Answer Other (Please Specify Below)

Other Race (If Applicable)

Enrolled at Triton? * Previously Currently Never Enrolled

Have you applied to the selected program above before at Triton College? * Yes No

If Yes, What Year did you Previously Apply?

If Yes, Please specify the program below and if you completed the program. If you did not complete program, please explain why in brief details

Have you attended other colleges? If yes, please submit transcripts to Records Dept. of Triton College Yes No

Education History (Please provides name(s) of each School, Degree or Certificate (If Applicable) and if you submitted School Transcripts to the Triton College Department of Records)

Have you ever attended an Information Session at Triton College (If Yes, Please specify below) Yes No

Information Session Attended (if Applicable)

Emergency Contact Information (Please provide Contact's Name, Address & Phone Number)

Answer the question below ONLY if you are a Diagnostic Medical Sonography Certificate Applicant (Otherwise, Leave blank)

Are you a current radiology tech? Yes No

Are you a current nuclear med tech? Yes No

By submitting this application to the Health Careers Selective Enrollment Program at Triton College, I attest that all information provided is complete and accurate.

I understand that submission of this application does not guarantee acceptance into any program. I am only eligible for selection based on meeting the program's requirements.

I also acknowledge that I am responsible for submitting ALL required documents and information to the Allied Health Department to determine my eligibility for the program(s).

I have read and understood the requirements and procedures for admission to the Selective Enrollment Programs, as outlined in the Application Information Packet.

Acknowledge Disclaimer * I agree

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