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Be sure to read the most current eligibility criteria for the Leadership Academy posted Under the Events tab at osrt.org. Complete and electronically submit the application below and the PDF file of your resume no later than May 15. Click the submission button below and upload the resume as directed. Multiple page resumes can only be uploaded as one PDF document. |
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| Full Name(*) |
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| Home Address(*) |
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| City(*) |
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| Home State(*) |
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| Home Zip(*) |
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| Preferred Phone-No dashes(*) |
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| Email(*) |
Please enter a valid email of the form userid@email.com |
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| Upload Resume (One PDF file only)(*) |
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In the text box below, indicate what you hope to gain by attending the OSRT Leadership Academy. (max 200 words) |
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| What do you hope to gain by attending the OSRT Leadership Academy?(*) |
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ATTESTATION STATEMENT
I certify, to the best of my knowledge, the information on this application is complete and accurate. Falsification of any information will cause my disqualification as an applicant to the Leadership Academy. Further, I understand it is my responsibility to make sure the application process is complete by the required deadline. If not, the application may be disqualified.
This application, upon receipt, becomes the property of the Ohio Society of Radiologic Technologists (OSRT).
I agree that, if selected for the Leadership Academy, the OSRT or its agents may use my name and likeness and any other information or materials provided in connection with the Academy for purposes of news, publicity and advertising in all media, including but not limited to print and electronic media, press releases, internet websites, and video media. |
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In the box below, enter the text you see. Click the refresh button if the characters are unclear. |
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| Form Verification(*) |
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