memberform

ACE Approval
Individual Course
Members Only Discount Price

    General Directions

    You will receive an invoice by email for the required $10 processing fee for each ACE request.

    The following items must be submitted with this completed form:

    • A syllabus or course description

    • A copy of your transcript with a "C" or better. The transcript must indicate if credits earned are quarter semester credits or semester credits.

    Course Syllabus or Description

    Transcript

    Contact Information

    Name

    Mailing Address

    Daytime Phone Number

    Email Address

    Licensed Modality

    RadiographyUltrasoundCV/InterventionalMammographyCTRadiation TherapyNuclear MedicineMRIOther

    Identification of Activity(Separate forms must be submitted for each course)

    Type of Activity

    Title of Activity

    Faculty/Instructor

    Dates of Activity

    Length of Activity

    Location

    Semester Completed (for college courses)

      You will receive an invoice by email for the required processing fee for each ACE request.