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Imaging Professional for Excellence

2026 Nomination Form

Please complete all fields below and submit your nomination.

View Guidelines

Nominator Information

Nominator's Name*

Nominator's Email*

Nominator's Phone

Nominee Information

Nominee Name*

Nominee Email*

Nominee Phone

Job Title & Employer

Credentials

Highest Degree

Years of Experience

Professional Involvement

Professional Society Memberships

Served on a committee within NCSRT or other society

Held an office for NCSRT or other society

Other

Work Related Involvement

Narrative

How does the nominee positively promote and advance the profession?

Describe the nominee’s character and integrity.

How does the nominee display commitment to patients, families, and colleagues?

Describe how the nominee assists in others’ professional growth.

Does the nominee radiate energy and make a difference?

If yes, explain why

In one sentence, what makes this person outstanding?

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Connect With Us:

North Carolina
Society of Radiologic Technologists

NCSRT
PO Box 393
Clemmons, NC 27012-0393

office@ncsrt.org

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About
- About NCSRT
- History
- Mission, Vision and Values
- Governance
- ASRT
Member
Students
- Jane Cox – Frances Apple Scholarships
- Student Contests
- ASRT SLDP
- RT Schools
Events
Advocacy
Volunteer
- Volunteer Statement Form
Sponsors
- Sponsorship Form
Shadowgraphs
Contact Us
- Board of Directors
- Committee Chairs

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