2022 – 2023 Volunteer Application Please enable JavaScript in your browser to complete this form.Name *FirstMiddleLastEmail *Valid email. Please provide an email that is regularly monitored.Phone *City/Region *Are you a member of the TXSRT? *YesNoIf "Yes", you will need your TXSRT member number. https://txsrt.org/membership-card/ . Login required.TXSRT Membership Number *Are you a member of the ASRT? *YesNoIf "Yes", you will need your ASRT member number. www.asrt.org. ASRT is encouraged, but not mandatory for all opportunities.ASRT Membership NumberAre you a professional or student? *Professional (registered in at least one primary modality)Student (non-registered individual; currently enrolled in an accredited medical imaging/ radiation therapy program)As a professional volunteer, I understand certain volunteer opportunities may require a current ARRT registry status, an active TMB licensure, and/or membership to the ASRT, TXSRT, and/or my local subordinate affiliate if applicable *I acknowledge the aforementioned criteriaI understand this does not disqualify me from volunteer, but may limit specific opportunities.Please check both statements after reading and accepting terms.Academic Credentials *AAS, BS, MS, PhD, etc.Clinical Credentials *ARRT, ARDMS, NMTCB, ARMRIT, etc. (ex: RT (R))Professional Credentials *CRA, CIIP, FACHE, etc.Other CredentialsAny miscellaneous category not previously described Enrollment ClassificationEx: 1st semester, 2nd semester, etc. or freshman, sophomore, junior, or seniorExpected Graduation DateFormat: TERM / YEAR (ex: Spring 2020)Name of InstitutionWhere are you currently enrolled?Modality of Program (Primary)Magnetic ResonanceNuclear MedicineRadiation TherapyRadiographySonography / UltrasoundOtherPlease explain Other (Modality)Program RepresentativeFirstLastOfficial representative / leader of your program (director, department chair, sponsoring faculty or administrator)Program Representative EmailValid email. Please ensure this email is regularly monitored.Program Representative Phone#Official Title of Program RepresentativeI am interested in the following student opportunities *Volunteering with committees, programs, and/or task forcesInternshipOtherChoose all applicable interestsPlease explain OtherArea of Interests / Career Aspirations *Example: Administration, Education, Corporate, etc. Please be as general or specific as appropriate. Information helps with intership/mentorship alignment.Please select all Committees and/or Coordinator positions you are interested in: *Affiliate Development CommitteeAnnual Meeting CommitteeBy-Laws CommitteeLegislative/Advocacy CommitteeNominations CommitteeTexas Student Leadership Development CommitteeEducation CoordinatorFundraising CoordinatorHistorian/PhotographerSocial Media CoordinatorStudent Contest Coordinator: Award of Merit EssayStudent Contest Coordinator: iLEAD PresentationsStudent Contest Coordinator: RAD T-ShirtStudent Contest Coordinator: Scientific PosterWebmasterFor more information, please review the Operational Guidebook with Standing Rules located on the txsrt.org home page under Operational Procedures of the main menu.Local Area Committee RegionAlamoCapitalCentralCoastal BendGulf CoastHigh PlainsSouth Texas BoarderSouthwest TexasUpper East TexasWest TexasIf you chose to volunteer to serve your Local Area Committee through the TSRT please select your Region in the dropdown. See full Texas Regions Map belowBriefly describe the skills, attributes, and/or experience you may possess to promote your success in the areas chosen above:How did you become aware of the TXSRT Volunteer Process? *TXSRT WebsiteTXSRT Communication (Email, Newletter, etc.)Direct Communication from a TXSRT memberPrevious Volunteering with TXSRTTXSRT Event (Annual Meeting / Seminar / Membership Drive / Etc.)OtherSelect the most accurate optionCommentSubmit
