Application Forms

Technologists Application Forms

To all Radiologic Technologists, Radiation Therapists, and Nuclear Medicine Technologists whose licensures are up for renewal, you will need your WebID letter and instructions to access your account.

Please use the online website to register/renew or apply for the first time at:https://nvrcp.aithent.com.   

• INFORMATIONAL NOTICE
• RCP Technologists Renewals
• Attestation Forms
  • Attestation of Employee Training
  • Attestation of Safe Injection Training
  • Facility Attestation of Employee Licensure

• License Application Forms
  • Full License (Click here to access our online system)
  • Limited License (Click here to access our online system)
  • Student License (Click here to access our online system)

• Registration Application Forms
  • Registration Form for CT or Fluoroscopy prior to 1-1-2020 (Click here to access our online system)
  • Registration Form for Radiation Therapy or Radiologic Imaging prior to 1-1-2020 (Click here to access our online system)
  • Registration form for Rural Authorization (Click here to access our online system)
  • Registration Form for the holder of a license to engage in Computed Tomography for Qualifying (Click here to access our online system)
  • Registration Form for the holder of a license or limited license to practice outside of scope (Click here to access our online system)

• Change of Address Form
• Name Change Form

• Recognized Continuing Education Organizations

Technologists Fees

Per LCB File No. R043-20 and R074-19, Adopted Regulations

• Technologists Licensing and Registration Fees

Mammography Application Forms

General Forms

• Notice to Employees Form
• Mammographer Certificate of Authorization Application (Click here to access our online system)
• Mammography Technologist Change of Information (Click here to access our online system)
• Mammography Technologist Termination Request (Click here to access our online system)
• Mammography Machine Application for Certificate of Authorization (Click here to access our online system)
• Mammography Machine Application for Certificate of Authorization - Addendum 1
• Mammography Machine Application for Certificate of Authorization - Addendum 2
• Mammography Machine Application for Certificate of Authorization - Addendum 3
• Non-MQSA Mammography Machine Annual Registration Form
• Mammography Physicians Supplement
• Template for Physician Experience

Mammography Guidance

• Basic Operational Requirements for Mammography
• Common Mammography Violations
• Adding and Deleting of Interpreting Physicians
• Model Letter for Adding a New Mammography Physician