Medical Imaging Externship Check List

Students are responsible for:

  • Finding a clinical site for the externship
  • Obtaining  permission from the course instructor:
  • Contacting  the AGENCY for health and safety requirements
  • Complying with all AGENCY health and safety, drug and alcohol tests, and criminal background check requirements
  • Submitting proof of completed health and safety requirements to Certified Background prior to starting the clinical experience.

Deadline Date

Externship check list must be completed 30 days prior to the start of the externship. There are no exceptions. If the externship checklist is not completed by the above deadline, the student will not be permitted to attend clinical for that semester.


Externship Checklist


State Authorization Approval. For a complete listing contact the Admissions Office or your program director.


Clinical site obtained


Clinical Affiliation Agreement complete. (Several of the hospitals in the Omaha metro area have affiliation agreements with Clarkson College; ask the externship instructor if an agreement is needed.)


Contact information for clinical liaison given to externship instructor. (Contact information should include: name, address, and phone number)


Meet with clinical liaison and complete a schedule for the semester.


Meet with externship instructor and discuss syllabus, clinical handbook and schedule.


Give externship instructor information for radiation badge distribution if applicable. (Date of birth and social security number)


Give externship instructor signed infraction form

9.___ Mammography & Pediatric Externships ONLY:  ARRT certification and state license

By signing below, I attest to the fact that I have not had any previous infractions within the RT/MI programs to include but not limited to:

  • Anecdotal report
  • Educational contract
  • Academic Integrity violation
  • Student Code of Conduct violation

Student Signature:  __________________________    Date:  ________________

*If infractions have occurred please set up an meeting with the appropriate externship instructor.