Grant Application

Submission Deadline: February 1

All questions must be answered to ensure consideration for all Grants.

Are you applying as a


	Part I. General Information - All Applicants

Student/Technologist must be an O.S.R.T. member at or before the time of registration at the annual meeting. The Honors and Awards committee will verify OSRT membership of all grant applicants. Transcripts are required, but raised-seals are no longer required; however, student transcripts must be signed by the program director to verify authenticity. Financial need is now a consideration in the grant judging criteria. (rev 10/04)

First Name:
Last Name:
Address:
City:
State:
Zip Code/County:
Home Phone:
Other Phone:
Email Address:
Academic Information - Registered Radiologic Technologists/Not applicable to Radiology Students
American Registry Radiologic Technologist Registry No.
Address:
City:
State:
Zip Code:
Name of Institution Currently Enrolled
Address:
City:
State:
Zip Code:
Date Last Attended:
No. of Credit Hrs. Completed:
Cumulative GPA:
Transcripts must be Submitted (see Application Process)
Present Employer:
Address:
City
State:
Zip Code:

Academic Information - Radiology Students
If Transfer Student Last School Attended:
Date Last Attended:
No. of Credit Hrs. Completed:
Cumulative GPA:
Name of Ohio Radiology Program Presently Enrolled:
Starting Date of Program:
Completion Date of Program:
Radiology GPA:
Official Transcripts must be Included (see Application Process)
Program Director's Name (Present)
Address:
City:
State:
Zip Code:
Program Director Phone Number:
Student Length of Enrollment in Program:
Is Student Currently Enrolled:	yes no
Signature of Program Director:




		Part II. All Applicants must complete the following-information to be considered for a Grant. If desired, essays may be typed and submitted on a separate sheet of papaer and attached to the application. Please list the professional organizations you are a member of, voluntary community service and explain why you are involved with each. In your own words, write a statement of not more than 100 words that identifies your professional goals and financial need for this Grant. Application Process: Submit transcripts and Grant Application to the OSRT Grant Committee prior to February 1. For student technologists, transcripts MUST be signed by the program director. Note: a raised seal is no longer required on the transcript. Grants are awarded on the basis of merit and academic ability and demonstrated financial need. Recipients must have a cumulative GPA of 2.75 on a 4.0 scale or a 3.44 on a 5.0 scale. Radiologic Technologists must have completed continuing education classes within one year prior to submission of application. Radiology Students must be enrolled in an accredited School of Radiologic Technology for a minimum of two quarters or one semester. Program Director MUST sign application to verify enrollment status. All applicants must be members of the OSRT at the time of application submission. PRINT and RETURN APPLICATIONS TO: OSRT Executive Secretary Dave Whipple, RT(R) 985 Preston Avenue Akron, Ohio 44305 (Fax) (866.405.6778 revised 10/07

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