Clinical Experience Form – Fill Out and Use This PDF

The Clinical Experience Form is an essential document for candidates seeking certification in various medical disciplines, such as Computed Tomography (CT), by the American Registry of Radiologic Technologists® (ARRT®). It serves to verify that candidates have successfully completed a specific subset of clinical procedures, which, along with theoretical knowledge, are crucial for acquiring the comprehensive clinical skills needed in diverse settings. To start your certification journey, ensure you fill out the Clinical Experience form by clicking the button below.

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Clinical Experience Form PDF Details

The ARRT Clinical Experience Form documents specific CT procedures required for certification. Beginning July 1, 2011, with subsequent revisions in 2012 and 2013, the current version requires candidates to list each procedure performed under qualified supervision within 24 months before application submission. Provided instructions on the form guide candidates through each page, with approximately 40 procedures across CT specialties including colonography and musculoskeletal imaging.

A qualified professional or supervisor at your facility reviews and verifies the completed form. Questions about specific procedures and required documentation are addressed in the ARRT® guidelines. This verification form is submitted as part of your standard application form. See also related documents: the Clinical Social Experience Verification and the ANCC Certification Verification form.

Question	Answer
Form Name	Clinical Experience Form
Form Length	7 pages
Issued By	American Registry of Radiologic Technologists® (ARRT®)
Purpose	CT Certification Experience Verification
Supervisor Required	Yes
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 45 sec
Other names	ct clinical experience document, ct clinical experience documentation form, Technologist, colonography

How to Edit Clinical Experience Form Online for Free

What Is the Clinical Experience Form?

The ARRT Clinical Experience Form is a required verification document for candidates applying for Computed Tomography (CT) certification. It records specific CT procedures performed under qualified supervision within 24 months before your application submission.

Who Needs to Complete This Form?

Radiologic technologists applying for ARRT CT certification must submit this form. A supervisor or qualified professional at your clinical facility reviews each listed procedure and provides written verification before you submit your application form.

Step-by-Step Instructions

Download the current version of the form from this page.
List every required CT procedure you have performed, noting the approximate date of completion.
Have your supervisor verify and sign each page of the completed form.
Answer all questions accurately - incomplete responses delay your application.
Submit the verified form with all provided documentation as part of your ARRT application.

Related Forms

If you need related clinical verification documents, see these forms: