Individuals must be current members of ASRT and their affiliate societies, with three consecutive years of ASRT membership and two consecutive years of affiliate membership, and not have previously completed the academy.

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* 1. First and Last Name

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* 2. ASRT ID Number

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* 3. Please upload your current affiliate card.

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* 4. Do you currently or have you previously served on the board of directors or in another volunteer capacity for an ASRT affiliate?

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* 5. What is your experience in advocating for the profession? 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 on a state radiation advisory committee, serving on the affiliate legislative committee or attending as an R.T. in a State Capitol meeting.

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* 6. Why do you believe you are a good candidate to participate in this program?

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* 7. What are your professional goals?

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* 8. How would participating in this program will help you attain your professional goals?

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* 9. What is your philosophy about ASRT’s role in the health care profession?

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* 10. What are your plans for volunteering and involvement in the affiliate and ASRT?

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* 11. Please attest by stating your full name that you understand this is a 17-week course and to complete the course it is mandatory to attend the onsite portion in March of 2027.

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