Carol Gildenberg Dichter Memorial PCS Scholarship
Nomination Form
CRITERIA: The Carol Gildenberg Dichter Memorial PCS Scholarship was created in 2003 to fund pediatric physical therapists who wish to become a Pediatric Clinical Specialist (PCS). The scholarship honors the memory of Carol Gildenberg Dichter, a longtime Academy member, former Chair of the Pediatric Specialty Council, and strong advocate of PCS. Scholarships will be awarded to active or life members of the Academy of Pediatric Physical Therapy (APPT), selected through a competitive process from among applications submitted. The funds may be used to pay for PCS exam fees, attend a course with advanced programming (such as Advanced Clinical Practice in Pediatrics or the APPT Annual Conference), continuing education credits, etc. Each applicant shall send a completed application form, one letter of recommendation, and curriculum vitae in the form of a single pdf. Please type all information.
Please send the complete application as a single pdf to no later than OCTOBER 1.
Name: ______
Complete Mailing Address: ______
City: ______State: ______Zip:______
Phone: ______
E-mail: ______
(If you receive the scholarship, we will require your Social Security Number to complete a 1099 form.)
1. Describe your professional involvement in APTA and APPT. What professional activities have you participated in or contributed to?
Years of APTA membership: ______Years of APPT membership: _____
2. What inspired you to pursue this specialization?
3. How will becoming a Pediatric Clinical Specialist affect your role as a pediatric physical therapist?
4. How do you intend to use the scholarship funds? How will this scholarship money make a difference in your pursuit of PCS?
5. When do you intend to sit for the PCS exam?
Updated 2/17