The Radiance Award

Award Application / Nomination Form
The Radiance Award

Awarded to a student actively enrolled in a medical imaging or radiation therapy program who demonstrates significant service or achievement to the profession, patients, peers, and the community at large.

Criteria:
- Must be nominated by a clinical preceptor, faculty, instructor, clinical coordinator, or program director who currently works directly in or with a medical imaging or radiation therapy educational program.
  - Nominating educators must provide proof of role (CV, resume, proof of employment, program documents listing their role, etc.)
- The nominating educator must submit a statement of 1 page or less highlighting why the nominee should be considered for this award
- Must demonstrate significant service or achievement in one or more of these areas
  - Advocacy and legislation
  - Service to the profession and patients
  - Service to the community at large as it relates to medical imaging and radiation therapy
  - Service to the program in which they are currently enrolled
  - Service to their peers

Nominee Information
Nominee Full Name

First NameMiddle NameLast Name
Role / Position
Organization / Program
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Nominator Information
Must be nominated by a clinical preceptor, faculty, instructor, clinical coordinator, or program director who currently works directly in or with a medical imaging or radiation therapy educational program.
Full Name

First NameMiddle NameLast Name
Role / Relationship to Nominee
Organization
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Supporting Documents
Upload Nominators Resume, CV, or other proof of current role.

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Upload a statement of 1 page or less highlighting why the nominee should be considered for this award

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Upload any additional documents that support this nomination.

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Award Criteria and Contributions
Please Select the Areas of Demonstrated Service/Achievement
Description of Nominee’s Contributions and Impact

Attestation and Submission Details
Attestation / Agreement
Submitter Name
Date

MonthDayYear
Date
Should be Empty: