ASRT BeRAD Award Form

Facility and Contact Information

Institution Name

Institution Representative for Purposes of This Application

Representative Email

Representative Phone

Representative Mailing Address

Demonstration of Professionalism

Establishing a Baseline of Professionalism

1. Does your institution have a policy requiring medical imaging technologists or radiation therapists to obtain credentials in their modality of practice?

Yes

No

If yes, please describe or include that policy in your application submission.

2. Does your institution have a policy, process or offering that supports the ongoing continuing education of your medical imaging technologists or radiation therapists?

Yes

No

If yes, please describe or include that policy in your application submission.

3. Does your institution have a policy, process or offering that promotes a team approach to patient-centered care and communication?

Yes

No

If yes, please describe or include that policy in your application submission.

Quality, Recognition and Advocacy in My Profession

1. Does your institution have a policy or process to support medical imaging technologist or radiation therapist involvement in professional associations?

Yes

No

If yes, please describe or include that policy in your application submission.

2. Does your institution have a policy or process to support staff in local community outreach involvement?

Yes

No

If yes, please describe or include that policy in your application submission.

3. Does your institution have policies and processes to provide quality and accessible patient care?

Yes

No

If yes, please describe or include that policy in your application submission.

4. Does your institution have a policy or process for the continuous improvement of quality and safety of patient care?

Yes

No

If yes, please describe or include that policy in your application submission.

5. Have any medical imaging technologists or radiation therapists from your institution received any professional awards, including from other associations, affiliates, the American Registry of Radiologic Technologists Gold Standard Awards or the Association for Medical Imaging Management (AHRA) Awards for Excellence?

Yes

No

If yes, please describe.

Lifelong Learning and Development

1. Does your institution have a policy, process or offering to support staff in obtaining educational degrees or courses?

Yes

No

If yes, please describe or include that policy in your application submission.

2. Does your institution have a policy or process to support staff in giving presentations or participating in peer-reviewed research?

Yes

No

If yes, please describe or include that policy in your application submission.

3. Does your institution have a process for promoting and maintaining professional standards where planned learning activities for students take place?

Yes

No

If yes, please describe or include that policy in your application submission.

Letters of Support

Please include two letters of support with your application. The letters should include how your department or institution promotes a culture of professionalism. Letters may not be from the named institution representative on the application.

One letter must be from a staff medical imaging technologist or radiation therapist.

One letter must be from a people leader or manager from another department or service line. We strongly encourage letters from vice presidents or executive level leadership. Examples include the chief nursing officer, vice president of clinical operations or chair of surgery. For outpatient clinics, this letter could be from a referring provider.

First Letter

Second Letter

Application for ASRT BeRAD Professionalism Award

Facility and Contact Information

Demonstration of Professionalism

Establishing a Baseline of Professionalism

Quality, Recognition and Advocacy in My Profession

Lifelong Learning and Development

Letters of Support

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