Radiation Safety Exam Application

Radiation Safety Exam Application Instructions

  1. All examination candidates must complete all sections of this application.
  2. This page is encrypted before being sent.
  3. The application fee is $180 for active nuclear medicine technologists.
  4. Payment information will be taken after you submit this form.
  5. The NMTCB accepts online payments by MasterCard® and Visa® credit card only.
  6. The date this application is submitted and payment is received is considered your official Application Date.

Instructions for Certified/Registered Nuclear Medicine Technologists who have held an active nuclear medicine technology certification (NMTCB, ARRT(N), CAMRT(N)) for a minimum of two (2) years.

  1. Complete the application below and Submit
  2. Pay application fee on next web page
  3. Provide a letter of attestation from a supervisor or the RSO stating you have performed tasks directly associated with radiation safety over a minimum period of one calendar year. An applicant who has been on a RAM license within the last 7 years can provide a copy of that license.

    Return the attestation letter to the NMTCB office at:
    1. By email to the Exam Manager at -OR-
    2. Fax to the Exam Manager at 404-315-6502 -OR-
    3. Mail via USPS to:
      NMTCB - Attn: Examinations Manager
      3558 Habersham at Northlake, Building I
      Tucker, GA 30084

RS Exam Application

Mr. Ms. Mrs. Dr.  
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MIDDLE INITIAL (one letter only)
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if Canadian, enter your Social Insurance Number
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What is your current nuclear certification?
(Check all that apply)
Have you been nuclear certified for a minimum of two (2) years?
Please list all certifications you hold
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Enter Date
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For this program, did you obtain a:
Associates Degree
Baccalaureate Degree
Master's Degree
Ethics Questions (Be advised that providing false or misleading information may result in permanent disqualification for any or all NMTCB examinations.)
a) ...been charged with or convicted of a misdemeanor (other than a minor traffic offense) or felony or general court martial in military service, and/or are any such charges currently pending against you?

If you answered 'Yes' to the above question, you must provide an explanation:
yes or no
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b)...had any professional license, registration, or certification application denied, or any issued license, registration, or certification revoked, suspended, placed on probation, or subject to any type of discipline by a regulatory authority or certification board?

If you answered 'Yes' to the above question, you must provide an explanation:
yes or no
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c) ...been found by any court or administrative body, including but not limited to employers, to have committed negligence (simple or willful), malpractice, recklessness, or engaged in misconduct in the practice of any profession?

If you answered 'Yes' to the above question, you must provide an explanation:
yes or no
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d) ...been terminated from an employment position involving the use of NMTCB credentials and where the conduct leading to such termination has involved: child or elder abuse, sexual abuse, substance abuse, job-related crimes, violent crimes against persons?

If you answered 'Yes' to the above question, you must provide an explanation:
yes or no
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If you answered yes to any question above, you MUST provide an explanation. Felony convictions require court documentation.
Read each of the following statements... Please initial below to indicate you have read and understand each of the statements...
NMTCB reserves the right to require and the applicant agrees to undergo, at the applicant’s expense, a national criminal background check through a source and under conditions determined by the NMTCB. NMTCB shall provide the applicant with a reasonable notice and period of time to complete this background check and the applicant agrees to cooperate in this regard.

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I have read, am in compliance with, and agree to continue compliance with all of the NMTCB’s rules and regulations, as may be revised from time to time by NMTCB, including, but not limited to, the NMTCB eligibility requirements, disciplinary and appeal procedures, certification, annual renewal, fees, ethics standards, and continuing education policy.

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I understand that any intentional or unintentional failure to provide true and complete responses to this application may result in denial of an application for certification or disciplinary action by the NMTCB.

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I authorize the NMTCB to confirm the information contained in this application and allow the NMTCB to request information related to my education, employment, relevant personal history, and professional license, registration, or certification.

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I hereby make application to the Nuclear Medicine Technology Certification Board, Inc. (NMTCB) for examination and certification in accordance with and subject to NMTCB rules and regulations adopted from time to time. I understand and agree to be bound by all rules and regulations adopted by the NMTCB.

I am enclosing the nonrefundable fee of $180.00 by electronic check or credit card payable to the NMTCB. I understand that any request to withdraw my application will be subject to the approval of the NMTCB. I also understand that if I fail to keep an appointment to sit for the examination, without approval from the NMTCB, I will be required to resubmit the entire application and applicable fee at the time of reapplication. I hereby submit this application and supporting documents and attest to the authenticity and accuracy of the application and all information contained herein. I also understand that, in the event that any information contained in this application or supporting documents submitted on my behalf, is determined by the NMTCB to be false or misleading, this application may be denied, entrance to the examination may be refused, examination score withheld or invalidated, and any other remedy available to the NMTCB, including adverse action against any already issued NMTCB certification. NMTCB also reserves the right in its sole discretion to turn such information over to state or federal administrative or criminal authorities.

It is my intent that this acknowledgment and authorization act as a release to all entities, including educational institutions, professional organizations, and/or employers, regarding the disclosure directly to NMTCB of all relevant information for purposes of processing my application. I acknowledge that the NMTCB will not release my score results or examination status to the general public. In an effort to assist program directors and medical directors to better evaluate the effectiveness of nuclear medicine technology programs, by signing below, I acknowledge that my examination results will be sent to such program officials. The NMTCB will verify, upon request from employer and state licensing agencies, whether or not an individual has an active certificate.

I agree to abide by all NMTCB policies and procedures related to the application and certification process. I hereby recognize the NMTCB owned intellectual property rights including the examination and its processes and agree to maintain the confidentiality of these copyrighted materials. I further understands that giving aid to or receiving aid from any third parties in taking this examination or advising any third parties of any of the questions or answers orally, in writing or through any media before, during or after the examination or other misuse of the NMTCB materials protected under intellectual property laws will be sufficient cause for the NMTCB to deny my application, withhold or invalidate my examination score, disqualify me from reexamination, impose an adverse action against an already issued NMTCB certificate, and any other remedy available to the NMTCB, including civil and criminal remedies under applicable laws.

Be advised that your name entered on this form constitutes your agreement with the statements in this application:

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(Enter Full Name)

Once you click the Submit button, you will be taken to a secure server where you may submit your payment. Your application will not be accepted and processed without payment.


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