Application

Criteria

Applicants for the ASRT Online Advocacy Academy must be a current member of the ASRT and affiliate society in the state that they live or work.

ASRT must receive this application and the applicant’s affiliate card must be on file with ASRT Volunteer Relations Department by May 12, 2024 at midnight to be eligible for consideration.

Directions

Before submitting this online application, we suggest you print a copy for your files. Once the application is submitted you cannot return to the same form, so please think your answers through carefully before submitting.

After the ASRT has received this submission, we will verify that you are a current ASRT member and member of your state’s affiliate society. If you do not have a current affiliate membership card on file with the ASRT Volunteer Relations Department, you will be notified and asked to submit one before you can be considered for the program.

1 Personal Profile

Member ID

First name

Last name

Phone number

2 Professional Profile

Job title

Department

Employer name

3 Affiliate Involvement

Which affiliate(s) do you belong to?

How long have you been a member of the affiliate society?

What positions have you held in your affiliate?

Please list any legislative or regulatory activities that you have been involved in at a state or national level.

Such as serving as a member on a state radiation advisory committee, serving on the affiliate legislative committee or attending as an R.T. in a State Capitol meeting.

4 Q and A

Why do you believe you are a good candidate to participate in the Advocacy Academy?

How would you use the information you have gained from participating in the ASRT Online Advocacy Academy?

How do you believe the ASRT Online Advocacy Academy will assist you in reaching your professional goals?

5 Applicant Certification

Select choices

I submit this application form for consideration as a participant in the ASRT Online Advocacy Academy. If chosen, I will comply with ASRT policies and will communicate with the Society in all matters.