DATE: _________________________ 
 
To Whom It May Concern, 
 
This is to verify that ____________________________________________ completed ______________ observation hours shadowing a Radiologic Technologist in the Diagnostic Imagining Department at ____________________________________________________________________.   
(Students should complete a minimum of four hours.) 
Radiology policies and procedures were explained and observed. 
Please include any additional comments below about what particular things the potential candidate observed during their time with you. 
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 
Evaluator: ______________________________________________________________  (Print) 
Signature: ______________________________________________________________