Senior Member Designation Request

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Contact Information

Please review the criteria for Senior Membership before submitting your request. Please note that requests will be reviewed in May 2017. Notifications of request status will be sent by May month-end.

* Required Fields


OSA Member #:
(if known)

*First Name:

*Last Name:

*Organizaton:

*Email Address:

Year joined OSA:
(if known)

*Curriculum Vitae (CV) or Resume

Please upload your curriculum vitae or resume below.

Please also include (as available):
  • Academic History
  • Professional Experience
  • Awards and/or Honors
  • Publications
  • Patents

Upload CV or Resume- 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 since the time of your highest degree and specify your total number of years of professional experience (outside of school, preferably beyond your highest degree). You can also forward supplemental documents using the contact information listed below.

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 below.

References

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  
*Name:

*Email:

   
Reference #2  
*Name:

*Email:

Optional: Additional Documents or Letters of Recommendation

Additional documents or letters of recommendation may be sent to:

Email: SeniorMember@osa.org
Fax: +1.202.558.7331
Mail: OSA Membership Department
2010 Massachusetts Ave NW
Washington, DC 20036 USA