Application

Criteria

Applicants for the ASRT Advocacy Training Program must be a current member of the ASRT.

ASRT must receive this application and if you have an affiliate card, please submit that to the ASRT Volunteer Services Department. Your affiliate card must be on file with us by May 16, 2025 at midnight to be eligible for consideration.

While ASRT affiliate society membership is encouraged, it is not required to participate in ATP.

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.

1 Personal Profile

Member ID

First name

Last name

Phone Number(s)

(home)

(cell)

(work)

Please check the box of your preferred phone number

(home)
(cell)
(work)

E-mail Address

(home)

(work)

Please check the box of your preferred email

(home)
(work)

2 Professional Profile

Job title

Department

Employer name

3 Affiliate Involvement (as applicable)

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

4 ASRT Involvement

Have you ever participated in ASRT advocacy programs? If yes, please list any ASRT volunteer opportunities you have previously done.

5 Q and A

Please provide a brief answer (2-3 sentences) to the questions below:

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

How would you use the information you have gained from participating in the ASRT Advocacy Training Program?

Why do you want to be involved in the Advocacy Training Program?

6 Applicant Certification

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

Signature

Date signed