Dr. James Johnston Administrator's Award

Your Name *

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Last

Your TxSRT Member Number *

If you are not familiar with your number, please log in at www.txsrt.org, select Print Membership Card. Your unique identification number will be displayed.

Your Email *

Please provide a valid and regularly monitored email.

Your Contact Number

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Nominee's Name *

First

Last

Nominee's Email *

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Nominee's Contact Number

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Is the nominee a member of TxSRT? *

Yes
No

If yes, please provide the nominee's TxSRT number, if known.

Employer / Organization *

Nominee's Title *

Nominee’s Official Title

Clinical Credentials *

(ARRT, ARDMS, NMCT, ARMRIT; ex: RT(R)(CT))

Academic Credentials

(BS, MBA, PhD)

Professional Credentials

(AHRA, ABII; ex: CRA, CIIP)

Have you ever worked with the nominee directly? *

Yes, I currently work with the nominee.
Yes, I previously worked with the nominee.
No, I have never worked with the nominee.

Do you directly report to or manage (immediately or upper level) this nominee? *

Yes
No
I work laterally to the nominee

Does the nominee directly manage others? *

Yes
No

For example: does this nominee have direct reports (scheduling, evaluations, official decision making, etc.)?

Why are you nominating this individual? *

Please be sure to include an detailed affirmative statement to the question. Include significant accomplishments, achievements, and contributions as leader this nominee has demonstrated.

Letter of Recommendation *

Drag & Drop Files, Choose Files to Upload You can upload up to 8 files.

At least one (1) letter of recommendation endorsing by a manager, coworker, or direct report (pdf. / Word doc. only) must be submitted.

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Dr. James Johnston Administrator’s Award

Qualifications

Recipients of the Administrator’s Award