Allied Health / School of Radiation Therapy - Request for Program Information

Thank you for your interest in Cooper University Hospital's School of Radiation Therapy. Please complete the form below to receive an application packet. Required fields are indicated with ( * ) Name: * Address: * City: * State: * Zip: * Daytime Phone: E-mail Address: * Where did you hear about our program? If other, please explain below (Format: xxx-xxx-xxxx) ARRT #: * Name of radiography school attended or currently attending: * Year graduated or expected year of graduation: *