Texas.gov Original Licenses Application

Process…

You are applying for the Medical Radiologic Technologist Temporary General Certificate

Personal Identification Information Section

Renewing Current License?(required) Are you renewing a current license that you hold with the Department of State Health Services? Yes No
Name of Applicant(required)
Prefix
Last Name(required)
First Name(required)
Middle Name
Suffix
Other Names Formerly Used
Birthdate(MM/DD/YYYY)(required)
Driver's License Number or State-Issued Identification Number(required)
Issuing State(required)
Social Security Number(###-##-####)(required)