Senior Nomination Form

OSA Senior Member Request

Contact Information

Please review the criteria for Senior Membership before submitting your request. Please note that requests are reviewed in May of each year. Notifications of request status are sent by May month-end.

If you are not currently an OSA member, please join online.

* Required Fields

OSA Member #:
(if known)

*First Name:

*Last Name:

*Email Address:

Year joined OSA:
(if known)

*Curriculum Vitae (CV)

Please upload your curriculum vitae below.

Please include:
  • Academic history
  • Professional experience
  • Awards and/or Honors
  • Publications
  • Patents

Upload CV - You can upload a .txt, .doc, .docx or .pdf file


*Contributions and Achievements


Professional Highlights - (4000 Character Maximum) Please provide a listing of your key professional achievements during the past 10 (or more) years. Feel free to forward supplemental documents using the contact information listed on the next screen.

Volunteer/Professional Society Activities - (4000 Character Maximum)Please list the professional organizations you belong to and the volunteer activities that you have taken part in. You may forward a separate document using the contact information listed on the next screen.


Brief endorsement statements from two current OSA Members are required. Each Senior Member applicant is to ask their references to complete an online referral form. Please note, the deadline for referral forms is the end of February for the May review.

Reference #1  


Reference #2  


Optional: Additional Documents or Letters of Recommendation

Additional documents or letters of recommendation may be sent to:

Fax: +1.202.416.6130
Mail: OSA Membership Department
2010 Massachusetts Ave NW
Washington, DC 20036 USA