Ohio Society of Radiologic Technologists

This form is to be completed and submitted by any first-year student interested in applying for the OSRT Student Director position. Before submitting this application, please review the criteria and information for this position. If selected, I agree to all requirements of the position and will fully support the Bylaws of the Society and conform to the policies and procedures adopted by the Society.

First Name(*)

Please provide your First Name.

Middle Name

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Last Name(*)

Please provide your Last Name.

Email Address (Please use personal email rather than program/work email))(*)

Please enter a valid email of the form userid@email.com

Home Phone-No dashes

Please provide your Home Phone Number.

Cell Phone-No Dashes(*)

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Ohio Imaging/Radiologic Science Program Name(*)

Please enter your program/school name.

Program Director Name(*)

Please enter your Program Director Name.

Program Start Month(*)

Please enter the month you started your technical studies.

Program Start Year(*)

Select Program Start Year

Graduation Month(*)

Please enter the month of your graduation.

Graduation Year(*)

Please enter the year of your graduation.

Are you currently actively enrolled in technical courses in your program?

YesNo

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Are you currently in good standing in your program?

YesNo

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To qualify, you must hold current student membership in OSRT. If you are not a current student member, you must first apply for membership online and receive a membership number before submitting this application.

OSRT Member ID#(*)

Please provide your OSRT membership number located on your membership card.

Narrative Statement - Please address the importance of professionalism and service to the profession and the Ohio Society of Radiologic Technologists. (200 words or less).(*)

Please address the importance of professionalism and service to the profession and the Ohio Society of Radiologic Technologists.

Narrative Prepared - Are you aware of and prepared to meet the expectations and the time commitment of being student director? (200 words or less)(*)

Are you aware of and prepared to meet the expectations and the time commitment of being student leader?

Narrative Committee - What OSRT Committee would you be interested in and why? (200 words or less)(*)

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Narrative Issue - What is one issue students in Ohio are currently facing and how can a professional organization address it? (200 words or less)(*)

What is one issue students in Ohio are currently facing and how can a professional organization address it?

Captcha(*)

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OSRT Student Director Application