TXSRT Volunteer Application - Welcome to TXSRT.ORG

Name *

First

Middle

Last

Email *

Valid email. Please provide an email that is regularly monitored.

Phone *

City/Region *

Are you a member of the TXSRT? *

Yes
No

If “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? *

Yes
No

If “Yes”, you will need your ASRT member number. www.asrt.org. ASRT is encouraged, but not mandatory for all opportunities.

ASRT Membership Number

Are 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 criteria
I 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 Credentials

Any miscellaneous category not previously described

Enrollment Classification

Ex: 1st semester, 2nd semester, etc. or freshman, sophomore, junior, or senior

Expected Graduation Date

Format: TERM / YEAR (ex: Spring 2020)

Name of Institution

Where are you currently enrolled?

Modality of Program (Primary)

Please explain Other (Modality)

Program Representative

First

Last

Official representative / leader of your program (director, department chair, sponsoring faculty or administrator)

Program Representative Email

Valid email. Please ensure this email is regularly monitored.

Program Representative Phone#

Official Title of Program Representative

I am interested in the following student opportunities *

Volunteering with committees, programs, and/or task forces
Internship
Other

Choose all applicable interests

Please explain Other

Area 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: *

For 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 Region

If 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 below

Briefly 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 Website
TXSRT Communication (Email, Newletter, etc.)
Direct Communication from a TXSRT member
Previous Volunteering with TXSRT
TXSRT Event (Annual Meeting / Seminar / Membership Drive / Etc.)
Other

Select the most accurate option