Ohio Society of Radiologic Technologists

This form is to be completed and submitted by any first-year student interested in applying for the OSRTERF Student Trustee Position. Before submitting this application, please review the criteria and information for this position on the Foundation page of the OSRT Website. 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

Invalid Input

Last Name(*)

Please provide your Last Name.

Email Address (use personal email address rather than school email address)(*)

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

Home Phone-No dashes

Cell Phone-No Dashes(*)

Please provide your Cell Phone Number.

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

Invalid Input

Are you currently in good standing in your program?

YesNo

Invalid Input

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.

Personal Narrative Statement -Please give a brief overview of who you are, your strengths, and discuss your commitment to fulfilling the duties of a Student Trustee (including a statement regarding your plan for managing the time commitment involved in serving on the Board). (200 words maximum)(*)

Please address strengths, commitment & managing the time commitment.

Profession Narrative - Include your reasons for choosing this profession, your professional goals, and how you might achieve these goals. (200 words maximum)(*)

List why you chose the profession, your goals, & how to achieve them.

Leadership Narrative - What are your leadership goals? How are you achieving or how do you plan to achieve these goals? (200 words maximum)(*)

List leadership goals and plan to achieve.

Upload Transcript PDF File(*)

Invalid Input

This form is to be completed and submitted by any first-year student interested in applying for the OSRTERF Student Trustee Position. Before submitting this application, please review the criteria and information for this position on the Foundation page of the OSRT Website. If selected, I agree to all requirements of the position and will fully support the policies and procedures of the Society and will conform to its bylaws.

OSRTERF Student Trustee Application