OSRT Foundation Technologist and Therapist Grant Application
Be sure to read the most current eligibility criteria for the Technologist/Therapist Grant posted on the Foundation Page of the OSRT Web site. Complete and electronically submit the official grant application and PDF file of the school transcript by March 1. Complete the application, upload your transcript as directed, and click the submission button below. The entire transcript must be uploaded in one file to be considered. Multiple page transcripts can only be uploaded as one document.
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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Cell Phone-No dashes(*)
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Other Phone-No Dashes
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Email-Use Personal Email Address(*)
Please enter a valid email of the form userid@email.com
Grant Category Choose 1(*)
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Educational Institution Enrolled(*)
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Program Name(*)
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Program Address(*)
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City(*)
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State(*)
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Zip Code(*)
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Start Date of Program(*)
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Expected Completion Date(*)
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Date Last Attended(*)
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You must upload a current program transcript (does not have to be official).
Upload Transcript (One PDF file only)(*)
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If applicable, list 1-2 professional, school, or community organization(s) in which you are a member and describe your participation in that organization, e.g., serving as an officer, director, committee chair, or committee member (100 word maximum)
Professional Organizations and Service(*)
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In the next two text boxes, fully and clearly describe professional goals and financial needs. In the first box, address your professional goals, and in the second box, address your financial needs for this for this grant (100 word limit for each topic).
Professional Goals(*)
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ATTESTATION STATEMENT I certify, to the best of my knowledge, that the information on this application is complete and accurate. Falsification of any information will cause my disqualification from the essay competition. 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 from the awards competition and may not be considered for an award. This application, upon receipt, becomes the property of the Ohio Society of Radiologic Technologists (OSRT). I agree that, if selected as an award winner for the OSRT Education and Research Foundation Grant Competition, the OSRT or its agents may use my name and likeness and any other information or materials provided in connection with this award 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. I understand that by providing school transcripts, I personally waive the provisions of the Family Educational Rights and Privacy Act of 1974, related to this submission. If you are under 18, your parent or guardian must also agree to these Terms and Conditions.
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List Voluntary Community Service, if applicable, according to criteria instructions (100 words maximum)...
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Financial Need(*)
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