VSRT Scholarship Form

Laura Ford Scholarship Application

Purpose
This Virginia Society of Radiologic Technologists scholarship will provide student radiographers with a financial incentive to complete their education in the medical imaging field or further their education in a specialty area.

Eligibility
1. Be a current member of the VSRT
2. A student attending a primary accredited medical imaging program such as radiography, radiation therapy, nuclear medicine, ultrasound, magnetic resonance imaging, or limited x-ray machine operator.
OR
A student attending or accepted to a program and continuing their education in a prescribed program, i.e., Nuclear Medicine, Radiation Therapy, Interventional procedures, Computed Tomography, Magnetic Resonance Imaging, Mammography, Radiology Administration, Radiologic Education, Sonography, Health Care Administration/Management or other post primary certification.

Registered imaging technologists are not eligible for the Laura Ford Scholarship. The Bencoach Technologist Scholarship is available for registered technologists.

Application Deadline
Completed applications must be electronically submitted by January 31, 2025, at 11:59 PM.

This includes:
1. Two Letters of Reference - emailed directly to scholarships@vsrt.org.
a. First reference must be from your Program Director or Program Faculty (It should include a letter of good standing on school letterhead).
b. The second reference should be from a technologist or radiologist (It cannot be from a family member).
2. Your VSRT member number and expiration date
a. Must be good through April
b. If you are not a member, you can apply at vsrt.org
3. Signed FERPA release form to your references and the VSRT
4. Copy of your official or unofficial transcripts (if the committee has questions, an official copy may be requested)
5. Complete the Essay Questions
6. Sign the application

The winner(s) will be announced at the VSRT Student, Educator and Technologist Annual Meeting in April. There is a $500 maximum per award and the scholarship is awarded directly to the student.

Selection Criteria
The scholarship committee will consider these items in selecting the award recipient(s):
1. Academic Achievement in an imaging program
2. Professional goals and insight
3. Merit

Applicant:*

Full Legal Name

Date of Birth:*

MM/DD/YYYY

Phone Number:*

Ex. (XXX) XXX-XXXX

Email Address*

example@example.com

Mailing Address:*

Street Address

Street Address Line 2

CityState

Zip Code

Program Name:*

School Name

Program Address:*

Street Address

Street Address Line 2

CityState

Zip Code

Degree/Diploma Type:*

Type of Degree/Diploma Awarded

Date of Graduation*

MM/DD/YYYY

Cumulative Grade Point Average*

(ex. 3.28 on a 4 pt. scale)

Please upload a copy of your unofficial college transcript (be sure it is current).*

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Please List Any Honors and/or Awards:

Please List Any Extra-Curricular / Volunteer Activities:

Letters of Recommendation

Please provide 2 formal letters of recommendation. These must be one from a program director/faculty and one from a technologist/radiologist (no family members). Letters should indicate the relationship to the Applicant, and provide a contact phone number and email for follow-up.

Letters should be sent directly to scholarships@vsrt.org by the person writing the letter, not the applicant.

Essay Prompts:

Submit a short essay to answer to each of the following questions (50-100 words per prompt). Essays should be typed and double-spaced. Click NEXT to upload your essay submission.

Prompt 1: What characteristics do you consider important in a professional technologist?

Prompt 2: Discuss what led you to medical imaging and your educational goals.

Prompt 3: Discuss your personal leadership abilities and how they will help you reach your goals.

Prompt 4: What are your professional goals and what is your plan to achieve them?

Click to attach your essay submission to this application.*

Upload a File

Max Total Upload Size: 500MB

Please download and complete the FERPA Release Form.

FERPA Release Form

Upload the completed FERPA release file.

Browse Files

Scholarship Terms and Conditions

Certification and Release Authorization. I/We certify that this information is complete and accurate. I/We authorize the release of this information to confirm and/or verify this application. I/We further grant unto the Virginia Society of Radiologic Technologists (VSRT), the right to use my name and likeness in connection with the promotion of the VSRT Scholarship fund on, but not limited to, our website, email distribution, and social media platforms.

I certify that I meet the eligibility criteria for the VSRT Scholarship Program, and have attached my transcript, essay submission, and 2 written recommendations. I understand that applications that are incomplete, late, or not submitted in accordance with directions will be ineligible for consideration.

I hereby apply for the VSRT Scholarship Program. I understand if I am selected to receive this Scholarship, the VSRT has no legal liability or obligation to me other than the payment of the Scholarship Award on my behalf to the accredited school listed above. I further understand that if I choose not to enroll after payment of the Scholarship, I am responsible to notify my school, and notify the VSRT of my decision.

Signature*

Signature Date:*

MM/DD/YYYY