{"id":3658,"date":"2021-12-21T22:02:42","date_gmt":"2021-12-22T04:02:42","guid":{"rendered":"https:\/\/www.jrcert.org\/?page_id=3658"},"modified":"2024-03-26T12:35:43","modified_gmt":"2024-03-26T17:35:43","slug":"program-forms","status":"publish","type":"page","link":"https:\/\/www.jrcert.org\/program-forms\/","title":{"rendered":"Program Forms"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\" id=\"program-forms\">Program Forms<\/h2>\n\n\n\r\n<div id=\"jrcert-faq-block_3976d69f8516fa7ea24bed9e1649439a\" class=\"faq\">\r\n\r\n    \r\n    \r\n        <div class=\"jrcert-faq-accordion-close\">\r\n            <a class=\"\" href=\"#\">\r\n                Expand All \/ Collapse All\r\n            <\/a>\r\n        <\/div>\r\n\r\n        <ul class=\"jrcert-faq-accordion\">\r\n\r\n        \r\n            <li class=\"jrcert-faq-item\" id=\"jrcert-faq-item-1\">\r\n                <h3 class=\"jrcert-faq-question\">\r\n                    Program Change Forms                    <i class=\"fa fa-plus-square\"><\/i>\r\n                <\/h3>\r\n\r\n                <div class=\"jrcert-faq-answer\">\r\n                    <div class=\"b40-list-block\">\n<p><span style=\"color: #355163;\">Please submit all forms via email to <a href=\"mailto:mail@jrcert.org\">mail@jrcert.org<\/a><\/span><\/p>\n<ul>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/1010R-Radiography-Clinical-Capacity-Change.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Clinical Capacity Change &#8211; Radiography<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/1010T-Radiation-Therapy-Clinical-Capacity-Change.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Clinical Capacity Change &#8211; Radiation Therapy<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/1010MR-Magnetic-Resonance-Clinical-Capacity-Change.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Clinical Capacity Change &#8211; Magnetic Resonance<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/1010MD-Medical-Dosimetry-Clinical-Capacity-Change.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Clinical Capacity Change &#8211; Medical Dosimetry<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/106-Clinical-Setting-Disaffiliation.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Clinical Setting Disaffiliation<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/108-Notification-of-Substantive-Change.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Substantive Change<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/Application-for-Transfer-of-Sponsorship-Final.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Transfer of Sponsorship<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/Template-for-Clinic-Preceptor.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Clinical Preceptor CV Template<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/Good-Cause-Extension-Request-Form-1-1-24.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Good Cause Extension Request Form<\/a><\/li>\n<\/ul>\n<\/div>\n                <\/div>\r\n            <\/li>\r\n            \r\n            \r\n            <li class=\"jrcert-faq-item\" id=\"jrcert-faq-item-2\">\r\n                <h3 class=\"jrcert-faq-question\">\r\n                    Program Effectiveness Data Template and Program Information Update                    <i class=\"fa fa-plus-square\"><\/i>\r\n                <\/h3>\r\n\r\n                <div class=\"jrcert-faq-answer\">\r\n                    <h2>Program Effectiveness Data Template<\/h2>\n<div class=\"b40-list-block\">\n<ul>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/Documents\/Forms\/Program-Forms\/PED-Templates\/Template_for_Radiography_Radiation_Therapy_and_Magnetic_Resonance.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Template for Radiography, Radiation Therapy and Magnetic Resonance<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/Documents\/Forms\/Program-Forms\/PED-Templates\/Template_for_Medical_Dosmimetry.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Template for Medical Dosimetry<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2023\/08\/PED-Template-for-LXMO.pdf\">Template for Limited Scope X-Ray Machine Operator (LXMO)<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/Documents\/Forms\/Program-Forms\/PED-Templates\/Template_for_Radiography_Radiation_Therapy_and_Magnetic_Resonance_with_Calculation-1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Template for Radiography, Radiation Therapy and Magnetic Resonance with Calculation<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/Documents\/Forms\/Program-Forms\/PED-Templates\/Template_for_Medical_Dosmimetry_with_Calculation-1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Template for Medical Dosimetry\u00a0with Calculation<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2023\/08\/PED-Template-for-LXMO-with-Calculation.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Template for Limited Scope X-Ray Machine Operator (LXMO) with Calculation<\/a><\/li>\n<\/ul>\n<\/div>\n<h2><strong>Program Effectiveness Data Website Examples<\/strong><\/h2>\n<div class=\"b40-list-block\">\n<ul>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/Documents\/Forms\/Program-Forms\/PED-Templates\/PED-template-example-RAD-RT-MR-1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Website example for Radiography, Radiation Therapy and Magnetic Resonance<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/Documents\/Forms\/Program-Forms\/PED-Templates\/PED-template-example-MD-1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Website example for Medical Dosimetry<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2023\/08\/Website-Example-for-LXMO-with-Calculation.pdf\">Website example for Limited Scope X-Ray Machine Operator<\/a><\/li>\n<\/ul>\n<\/div>\n<div class=\"b40-list-block\">\n<h2><strong>Program Information Update Form (for 2022 Program Annual Report)<br \/>\n<\/strong><\/h2>\n<ul>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/Program-Information-Update.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Program Information Update Form<\/a><\/li>\n<\/ul>\n<\/div>\n                <\/div>\r\n            <\/li>\r\n            \r\n            \r\n            <li class=\"jrcert-faq-item\" id=\"jrcert-faq-item-3\">\r\n                <h3 class=\"jrcert-faq-question\">\r\n                    Curriculum Analysis Grids                    <i class=\"fa fa-plus-square\"><\/i>\r\n                <\/h3>\r\n\r\n                <div class=\"jrcert-faq-answer\">\r\n                    <p><span style=\"color: #355163;\">The curriculum grid is intended to assure the latest American Society of Radiologic Technologists (ASRT) or American Association of Medical Dosimetrists (AAMD) professional curriculum is utilized by the program.<\/span><\/p>\n<h2><span style=\"color: #355163;\">Curriculum Analysis Grids<\/span><\/h2>\n<div class=\"b40-list-block\">\n<ul>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/2022-Radiography-Curriculum-Analysis-Grid.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">2022 Radiography Curriculum Analysis Grid<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/2019-Radiation-Therapy-Curriculum-Analysis.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">2019 Radiation Therapy Curriculum Analysis Grid<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/2019-Medical-Dosimetry-Curriculum-Analysis.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">2019 Medical Dosimetry Curriculum Analysis Grid<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/2020-Magnetic-Resonance-Curriculum-Analysis.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">2020 Magnetic Resonance Curriculum Analysis Grid<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/2021-LXMO-Curriculum-Analysis-Grid.pdf\">2022 Limited Scope X-Ray Machine Operator Curriculum Analysis Grid<\/a><\/li>\n<\/ul>\n<\/div>\n                <\/div>\r\n            <\/li>\r\n            \r\n            \r\n            <li class=\"jrcert-faq-item\" id=\"jrcert-faq-item-4\">\r\n                <h3 class=\"jrcert-faq-question\">\r\n                    Templates                    <i class=\"fa fa-plus-square\"><\/i>\r\n                <\/h3>\r\n\r\n                <div class=\"jrcert-faq-answer\">\r\n                    <div class=\"b40-list-block\">\n<ul>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/Website-Compliance-Checklist.docx\">Website Compliance Checklist<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/Website-Compliance-Checklist-LXMO.docx\" target=\"_blank\" rel=\"noreferrer noopener\">Website Compliance Checklist (LXMO)<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/Documents\/Forms\/Program-Forms\/Templates\/Assessment-Goal-Template.docx\" target=\"_blank\" rel=\"noreferrer noopener\">Assessment Plan SLO and Analysis Template<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/Documents\/Forms\/Program-Forms\/Templates\/Meeting-Minutes-Template.docx\" target=\"_blank\" rel=\"noreferrer noopener\">Meeting Minutes Template<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/Documents\/Forms\/Program-Forms\/Templates\/Curriculum-Map-Template.xlsx\" target=\"_blank\" rel=\"noreferrer noopener\">Curriculum Map Template<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/Template-for-Clinic-Preceptor.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Clinical Preceptor CV Template<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2024\/03\/Final-Mammography-Template.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Imaging Rotations Policy Template<\/a><\/li>\n<li><a href=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2023\/09\/Sample-MRI-Student-Screening-Form.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Magnetic Resonance (MR) Screening Form for Students<\/a><\/li>\n<\/ul>\n<\/div>\n                <\/div>\r\n            <\/li>\r\n            \r\n            \r\n            <li class=\"jrcert-faq-item\" id=\"jrcert-faq-item-5\">\r\n                <h3 class=\"jrcert-faq-question\">\r\n                    Recognition Certificates                    <i class=\"fa fa-plus-square\"><\/i>\r\n                <\/h3>\r\n\r\n                <div class=\"jrcert-faq-answer\">\r\n                    <div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large is-resized\"><span style=\"color: #000000;\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-774\" src=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2021\/11\/certificate-of-excellence-1024x709.jpeg\" sizes=\"(max-width: 533px) 100vw, 533px\" srcset=\"https:\/\/www.jrcert.org\/wp-content\/uploads\/2021\/11\/certificate-of-excellence-1024x709.jpeg 1024w, https:\/\/www.jrcert.org\/wp-content\/uploads\/2021\/11\/certificate-of-excellence-300x208.jpeg 300w, https:\/\/www.jrcert.org\/wp-content\/uploads\/2021\/11\/certificate-of-excellence-768x532.jpeg 768w, https:\/\/www.jrcert.org\/wp-content\/uploads\/2021\/11\/certificate-of-excellence.jpeg 1040w\" alt=\"\" width=\"533\" height=\"369\" \/><\/span><\/figure>\n<\/div>\n<h3><span style=\"color: #355163;\">Certificate of Excellence Award for Students Request<\/span><\/h3>\n<p><span style=\"color: #355163;\">The purpose of this award is to recognize a student graduating from a JRCERT accredited program for achieving excellence in the radiologic sciences.\u00a0 The criteria for the award and the selection of the recipient is the prerogative of the program officials and its faculty.\u00a0 Each accredited program is limited to one award per year.<\/span><\/p>\n<p><span style=\"color: #355163;\"><strong>Program Directors:<\/strong>\u00a0 Send an email with the program name, number, nominee, presentation date to\u00a0<a style=\"color: #355163;\" href=\"mailto:mail@jrcert.org\">mail@jrcert.org<\/a>.<\/span><\/p>\n<h3><\/h3>\n<h3><span style=\"color: #355163;\">Certificate of Excellence Award for Clinical Educators<\/span><\/h3>\n<p><span style=\"color: #355163;\">The purpose of this award is to recognize a clinical educator from a JRCERT accredited program for achieving excellence in the radiologic sciences.\u00a0 The criteria for the award and the selection of the recipient is the prerogative of the program officials and its faculty.\u00a0 Each accredited program is limited to one award per year.<\/span><\/p>\n<p><span style=\"color: #355163;\"><strong>Program Directors:<\/strong>\u00a0 Send an email with the program name, number, nominee, presentation date to\u00a0<a style=\"color: #355163;\" href=\"mailto:mail@jrcert.org\">mail@jrcert.org<\/a>.<\/span><\/p>\n<h3><\/h3>\n                <\/div>\r\n            <\/li>\r\n            \r\n            \r\n        \r\n        <\/ul>\r\n\r\n    \r\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Program Forms<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"0","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"footnotes":""},"acf":[],"ticketed":false,"_links":{"self":[{"href":"https:\/\/www.jrcert.org\/wp-json\/wp\/v2\/pages\/3658"}],"collection":[{"href":"https:\/\/www.jrcert.org\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.jrcert.org\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.jrcert.org\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.jrcert.org\/wp-json\/wp\/v2\/comments?post=3658"}],"version-history":[{"count":52,"href":"https:\/\/www.jrcert.org\/wp-json\/wp\/v2\/pages\/3658\/revisions"}],"predecessor-version":[{"id":24173,"href":"https:\/\/www.jrcert.org\/wp-json\/wp\/v2\/pages\/3658\/revisions\/24173"}],"wp:attachment":[{"href":"https:\/\/www.jrcert.org\/wp-json\/wp\/v2\/media?parent=3658"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}