ASRT Fellow Application (Reference Document Only)

The honorary category of Fellow is bestowed upon members who have made outstanding contributions to the radiologic technology profession and to the ASRT. This category was initiated within the ASRT to honor members who were dedicated to the organization and contributed unselfishly to the profession. The first class of 12 technologists was elevated to Fellow status in 1956. Each Fellow has committed to the advancement of the profession at the district, state, regional, national and international levels.

All applications must be submitted on a current Fellow application. Reformatting the online application will result in disqualification of the application. If additional space is needed, upload a separate sheet in the appropriate section. The minimum number of points required for consideration for elevation to Fellow is 80; 45 of these points must be earned in Section A. No more than 50% of the total points in each section may come from a single category within that section. Activities or service not appearing on the Fellow Point Evaluation Scale will not be reviewed.

Applicant Information

______Name of Applicant (Full name as it should appear on certificate)

______Address City State ZIP

______Primary phone Fax E-mail Member Number

______Sponsor Name Primary phone E-mail

A. ASRT Professional Society Activities 1. Member of ASRT Board of Directors – 4 points per year Position Year Points Sponsor Verification

Subtotal (Section 1)

Page 1 of 17

2. Member of ASRT Foundation Board of Trustees – 2 points per year Position Year Points Sponsor Verification

3. ASRT Committee Chairman – 2 points per year List out Foundation Committees as a section. Chair and Committee Chairman should be listed separately. Committee Year Points Sponsor Verification

4. ASRT Committee Member – 1 point per year Committee Year Points Sponsor Verification

5. ASRT Task Force Chairman – 2 points per year Task Force Year Points Sponsor Verification

Subtotal (Sections 2-5)

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6. ASRT Task Force Member – 1 point per year Task Force Year Points Sponsor Verification

7. ASRT Subcommittee Chairman or Member – 0.5 points per year Task Force Year Points Sponsor Verification

8. ASRT Appointee to JRCs ─ 1 point per year Organization (JRC)/Position Year Points Sponsor Verification

9. ASRT Appointee to ARRT Board of Trustees – 1 point per year Position Year Points Sponsor Verification

10. ASRT Appointee to the ISRRT Council – 1 point per year Position Year Points Sponsor Verification

Subtotal (Sections 6-10)

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11. ASRT ECE® Zone Counselor – 1 point per year Position Year Points Sponsor Verification

12. ASRT Appointees to External Organizations (FDA, The Joint Commission, etc.) ─ 0.5 points per year Organization Year Points Sponsor Verification

13. ASRT Appointees to Project Work Groups (ASRT curriculum project work group, etc.) ─ 1 point per year Project Year Points Sponsor Verification

14. ASRT Editorial Review Board Chairman – 2 points per year Year Points Sponsor Verification

15. ASRT Editorial Review Board Member – 1 point per year Year Points Sponsor Verification

Subtotal (Sections 11- 15)

Page 4 of 17

16. ASRT Affiliate Delegate – 1 point per year Affiliate Year Points Sponsor Verification

17. ASRT Chapter Delegate – 1 point per year Chapter Year Points Sponsor Verification

18. ASRT Commission Chairman – 2 points per year Commission Year Points Sponsor Verification

19. ASRT Commission Member – 1 point per year Commission Year Points Sponsor Verification

20. ASRT Chapter Delegate Chairman – 1 point per year Steering Committee Year Points Sponsor Verification

21. ASRT Reference Committee Chairman – 1 point per year Reference Committee Year Points Sponsor Verification

Subtotal (Sections 16-21)

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22. ASRT Reference Committee Member ─ 0.5 points per year Committee Year Points Sponsor Verification

23. ASRT Committee on Credentials, Tellers, Sergeant-at-Arms ─ 0.5 points per year. 2.5 points maximum. Committee Year Points Sponsor Verification

24. ASRT Leadership Academy Graduate ─ .5 points. – 1.5 maximum points allowed. Leadership Academy Graduate .5 point Leadership Academy for Educators .5 point Educator’s Institute .5 point Year Points Sponsor Verification

25. ASRT Active Member (requires a minimum of 10 years of consecutive current membership) After 10 consecutive years of ASRT membership, 1 point is awarded per year for the first 5 years (i.e., years 11 to 15), and 0.5 points per subsequent year (maximum 10 points) ASRT Member # Year Points Sponsor Verification

26. ASRT Life Member – 1 point Year Points Sponsor Verification

Subtotal (Sections 22-26)

Page 6 of 17

27. ASRT Conference Lecturer – 1 point per hour A lecture can only be used once for full credit; subsequent presentations earn half credit. Title Society and Meeting Site Date Points Sponsor Verification

28. ASRT-assigned Lecturer to External Organization (NCRP, CDRH, etc.) – 1 point per hour A lecture can only be used once for full credit; subsequent presentations earn half credit. Title Society and Meeting Site Date Points Sponsor Verification

29. ASRT Scientific Exhibitor – 1 point per exhibit Virtual exhibits may be included in this section. Title Society and Meeting Site Date Points Sponsor Verification

Subtotal (Sections 27-29)

Page 7 of 17

30. ASRT Publication of Scholarly Peer-reviewed Article or Directed Reading First Author 3 points Second Author 2 points Third Author 1 point Parallel publication (peer reviewed) is counted as part of the original, as one publication, no points are awarded and .5 points if reprinted in other publications. Title Journal Month/Year Author Points Sponsor of Issue Position Verification

31. ASRT Self-learning Activity – Homestudy/Video/Tape/CD First Author 3 points Second Author 2 points Third Author 1 point Parallel publication (peer reviewed) is counted as part of the original, as one publication, no points are awarded and .5 points if reprinted in other publications. Title Description Date of Author Points Sponsor Issue Position Verification

32. ASRT Awards – Jean I. Widger Distinguished Writing Award, Harold Silverman Distinguished Author Award, Ed Jerman-John B. Cahoon Memorial Lecture, Varian Award in Honor of Eileen McCullough – 1 point per award Award Date of Award Points Sponsor Verification

Subtotal (Sections 30-32)

Page 8 of 17

33. ASRT Participation in R.T. in D.C. – 0.5 points per year Year Points Sponsor Verification

34. Author of a funded ASRT Foundation research grant Principle Investigator – 2 points Co-Principle Investigator – 1 point Title Award Amount Year Points Sponsor Verification

Subtotal (Sections 33-34)

Total Points for Section A

Page 9 of 17

B. Other Professional Contributions 1. ASRT Region Officer – 1 point per year, 3 points maximum Office Region Year Points Sponsor Verification

2. Affiliate Level – affiliate activities only – district/chapter activities do not receive credit. a. Active member (after five years of consecutive membership) ─ 1 point per year, 5 points maximum Years of Active Affiliate Society Points Sponsor Membership Verification

b. Board member – 2 points per year Position or Office Affiliate Society Year Points Sponsor Verification

c. Chairman or member of a committee – 1 point per year Position or Committee Affiliate Society Year Points Sponsor Verification

Subtotal (Sections 1-2c)

Page 10 of 17

d. Chairman of affiliate annual conference – 1 point per year Meeting Site Affiliate Society Year Points Sponsor Verification

e. Chairman or member of state licensing or certification board – 1 point per year Position State Year Points Sponsor Verification

f. Lecturer – 1 point per hour A lecture can only be used once for full credit; subsequent presentations earn half credit. The lecture must be RCEEM approved. Title Society and Meeting Site Date Points Sponsor Verification

g. Scientific Exhibitor – 1 point per exhibit Title Society and Meeting Site Date Points Sponsor Verification

Subtotal (Sections 2d-g) Page 11 of 17

h. Editor of Affiliate Publication ─ 1 point Affiliate Name of Publication Dates Points Sponsor Verification

i. Life Member ─ 1 point Affiliate Year Points Sponsor Verification

3. External Organizations a. JRC site visitor (chairman or member) – 1 point per year. Position Organization Year Points Sponsor Verification

b. Certification board item writer (ARRT) or equivalent – 1 point per year Documented service from the ARRT or equivalent organization determined by ASRT recognition at the time of service. Position Credentialing Agency Year Points Sponsor Verification

c. Certification board examination committee (ARRT or equivalent) – 1 point per year Documented service from the ARRT or equivalent organization determined by ASRT recognition at the time of service. Position Credentialing Agency Year Points Sponsor Verification

Subtotal (Sections 2h-3c)

Page 12 of 17

4. Publications a. Author of scholarly peer-reviewed article in a national or international journal (other than ASRT) First Author 2 points Second Author 1 point Third Author 0.5 points Parallel publications (peer reviewed) is counted as part of the original, as one publication, no points are awarded and .5 points if reprinted in other publications. Title Journal Month/Year Author Points Sponsor of Issue Position Verification

b. Author of textbook related to the radiologic sciences First Author 6 points Second Author 3 points Third Author 2 points Reprints in other languages are not eligible. See 50% Rule. Title Month/Year Author Points Sponsor Verification of Issue Position

c. Editor of textbook related to the radiologic sciences First Editor 4 points Second Editor 2 points Third Editor 1 point Title Month/Year Editor Points Sponsor Verification of Issue Position

Subtotal (Sections 4a-c)

Page 13 of 17

d. Author of textbook chapter related to the radiologic sciences First Author 2 points Second Author 1 point Third Author .5 points Title Month/Year Author Points Sponsor Verification of Issue Position

5. Professional Practice a. Nationally recognized radiographic imaging and therapeutic position or technique (published in a textbook or peer-reviewed scholarly journal) ─3 points Title of Position or Technique Month/Year of Points Sponsor Verification Issue

b. Nationally recognized radiographic imaging and therapeutic accessory, instrument or teaching aid ─ 3 points Name/Description Points Sponsor Verification

6. Postsecondary Education (highest degree only awarded points) a. Associate degree – 2 points College City and State Dates Attended Points Sponsor Verification

Subtotal (Section 4d-6a)

Page 14 of 17

b. Baccalaureate degree – 4 points College City and State Dates Attended Points Sponsor Verification

c. Master’s degree – 6 points College City and State Dates Attended Points Sponsor Verification

d. Doctorate degree – 8 points College City and State Dates Attended Points Sponsor Verification

7. Certification a. Additional disciplines in the radiologic sciences ─ 3 points. Candidate will receive 3 points for initial certification and will receive 3 points for each subsequent certification. Not to exceed 6 points. Discipline Credentialing Date Certificate Points Sponsor Verification Body Certified Number

b. Postprimary certifications from ABII, ARDMS, ARRT, CCI, ISCD, NMTCB and RACC – 1 point Examination Credentialing Date Certificate Points Sponsor Verification Body Certified Number

c. Advanced practice certifications from ARRT, CBPRA and NMTCB – 1 point maximum Examination Credentialing Date Certificate Points Sponsor Verification Body Certified Number

Subtotal (Section 6b-7c)

Page 15 of 17

8. Professional Employment - Combination of 8a and b may not exceed 12 points. a. Each year of full-time employment (minimum of 32 hours per week) related to the radiologic sciences – 1 point per year up to 12 points maximum. Institution and Position Title No. of Points Sponsor Verification Location years employed

b. Each year of part-time employment (minimum of 16 hours per week) related to the radiologic sciences. 0.5 points per year up to 12 points maximum. Institution and Position Title No. of Points Sponsor Verification Location years employed

Subtotal (Section 8-8b)

Page 16 of 17

9. Grants – a. Author of a funded external research grant Principle Investigator – 1 point Co-Principle Investigator – .5 point Title Award Amount Year Points Sponsor Verification

b. Author of a funded external service grant (equipment, start up, etc.) Author or co-author - .5 point

Title Award Amount Year Points Funding Sponsor Agency Verification

Subtotal (Section 9-9b)

Total Points for Section B Minimum number of points required for consideration for elevation to Fellow is 80; 45 of these must be earned in Section A.

Points for Section A ______Points for Section B ______

Total Points ______

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