Technologist of the Year Nomination

The Nebraska Society of Radiologic Technologists

An Affiliate of the American Society of Radiologic Technologists
TECHNOLOGIST OF THE YEAR NOMINATION

Honoring outstanding contributions to radiologic technology, medical imaging, and radiation therapy. Please complete the following nomination form to the best of your ability. Comprehensive responses are encouraged; however, it is acceptable if you are unable to answer every question in full. The NSRT may follow up with you for additional information or clarification as needed. Completed nomination forms must be submitted through the NSRT website no later than January 1.
Your Name

First NameLast Name
Your email to contact if we have follow-up inquiries.
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Nominee Name:

First NameLast Name
Nominee Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nominee Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Professional Memberships
Is the nominee a member of professional organizations (e.g., NSRT, ASRT, ARRT, AEIRS or others)?
Educational Background
Where did the nominee receive their initial education and credentials in radiologic technology, medical imaging, or radiation therapy? Please include the name of the institution and year of graduation, if known. Additionally, list any advanced degrees, certifications, or continuing education the nominee has completed.
Leadership and Volunteer Involvement
How has the nominee demonstrated leadership or contributed through volunteer work—either within professional organizations or the broader community?
Community Engagement
Is the nominee involved in any non-radiologic organizations, service groups, or community initiatives? Please describe any service activities.
Professional Goals
What are the nominee’s current professional goals or plans for future growth in the field?
Impact on the Profession
In what ways does the nominee actively support or mentor others within the profession? Please describe how they contribute to the growth, education, or professional development of students, coworkers, or peers in their daily work.
Professional Qualities and Character
What personal and professional qualities best define the nominee? Consider attributes such as integrity, leadership, work ethic, compassion, or commitment to excellence. If possible, share a specific example or scenario that illustrates these qualities in action.
Strengths and Areas of Growth
What do you consider the nominee’s greatest strengths? Are there any areas where they continue to grow?
Public Awareness
In what ways does the nominee help promote awareness or understanding of the radiologic sciences to the public?
Current Role and Professional Service
Where does the nominee currently work, and what is their role? Describe how they serve their patients, coworkers, and organization. Consider how they contribute to a positive work environment, support quality care, or go above and beyond in their daily responsibilities.
Additional Comments
Is there anything else you would like us to know about the nominee?
Thank you for taking the time to recognize an outstanding imaging professional.

The NSRT Board of Directors will carefully review all nominations and vote to select the recipient of the Technologist of the Year Award. If selected, the nominee will be invited to attend the annual NSRT Conference to be recognized and presented with the award. The honoree will also receive a complimentary one-year membership to the NSRT.

We appreciate your contribution to celebrating excellence in the radiologic sciences.
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The Nebraska Society of Radiologic Technologists

TECHNOLOGIST OF THE YEAR NOMINATION

Professional Memberships

Educational Background

Leadership and Volunteer Involvement

Community Engagement

Professional Goals

Impact on the Profession

Professional Qualities and Character

Strengths and Areas of Growth

Public Awareness

Current Role and Professional Service

Additional Comments