OSRTERF Student Trustee Application
  1. 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 Code of Regulations of the Society and conform to the Code of Ethics adopted by the Society.
  2. First Name(*)
    Please provide your First Name.
  3. Middle Name
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  4. Last Name(*)
    Please provide your Last Name.
  5. Email Address (use personal email address rather than school email address)(*)
    Please enter a valid email of the form userid@email.com
  6. Home Phone-No dashes
  7. Cell Phone-No Dashes(*)
    Please provide your Cell Phone Number.
  8. Ohio Imaging/Radiologic Science Program Name(*)
    Please enter your program/school name.
  9. Program Director Name(*)
    Please enter your Program Director Name.
  10. Program Start Month(*)
    Please enter the month you started your technical studies.
  11. Program Start Year(*)
    Select Program Start Year
  12. Graduation Month(*)
    Please enter the month of your graduation.
  13. Graduation Year(*)
    Please enter the year of your graduation.
  14. Are you currently actively enrolled in technical courses in your program?
    Invalid Input
  15. Are you currently in good standing in your program?
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  16. 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.
  17. OSRT Member ID#(*)
    Please provide your OSRT membership number located on your membership card.
  18. Personal Narrative Statement - Please discuss your commitment to fulfilling the duties of a Student Trustee. (200 words maximum).(*)
    Please address the importance of professionalism and service to the profession and the Ohio Society of Radiologic Technologists.
  19. Profession Narrative - Why do you want to be in this profession? (200 words maximum)(*)
    Are you aware of and prepared to meet the expectations and the time commitment of being student leader?
  20. Leadership Narrative - What are your leadership goals? How are you achieving or how do you plan to achieve these goals? (200 words maximum)(*)
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  21. Form Verification
    Enter the text you see in the text field.(*)
    Form Verification<br />Enter the text you see in the text field. RefreshPlease check the validation code and try again.
  23. This form is to be completed and submitted by any first-year student interested in applying for the OSRTERF Student Trustee Program. 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 Code of Regulations of the Society and to conform to the Code of Ethics adopted by the Society.