Authorized medical physicist application - Environmental 2026

1. Click ‘Get Form’ to open the authorized medical physicist application - Environmental in the editor.
2. Begin by completing Part 1 of the form. Fill in your name, UVa Computing ID, and answer the questions regarding your current status as an AMP.
3. If applicable, provide your license number and agency if you are currently an AMP. If not, indicate your board certification status and attach a copy if certified.
4. Select the modalities for which you are requesting authorization by checking the appropriate boxes.
5. Review all information for accuracy, sign and date at the end of Part 1, and ensure all required documents are attached.
6. Submit the completed form via email to the Radiation Safety Officer (RSO) as instructed.

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