Student Assembly

Nominee Questionnaire

INSTRUCTIONS:Please complete this questionnaire to assist the Nominating Committee in its candidate selection process for the Student Assembly Board of Directors.Please type your answers.If you have any questions, please email .

DEADLINE: Please submit your completed questionnaire via email to y July 22at 11:59pm, EST.Be sure to also include yourcandidate statement, photo, and resume as attachments or in separate emails.

  1. I am qualified to serve on the Student Assembly Board of Directors because (remember to include pertinent leadership experience and involvement in promoting the physical therapy profession):
  1. If elected to the SABoD, I hope to accomplish these 2-3 goals (please provide what resources you may use to accomplish these goals and if they are long-term):
  1. What has influenced you during your SPT/SPTA experience that has motivated you to want to become involved beyond the classroom?
  1. My vision(s) for the future development of the Student Assembly and the physical therapy profession is:
  1. Other areas of my professional or community experience include:
  1. Candidate Statement: Please submit your statementas a separate documentto statements should be limited to250 words or less, using 12-point Times New Roman font and single spacing.If you are slated as a candidate, these statements will be posted on the student page of APTA’s Web site and promotedat NSC.Please note that you will have time before NSC to adjust your statement as desired if you are slated as a candidate for a position other than the one you originally applied for.In your statement, please focus on why you intend to run for office, what your strengths are, and what you hope to achieve.
  1. Photo:Please submitan electronicphoto that has been produced by a high-resolution camera (not a camera phone, a copied photo, etc).This usually produces a photo that is 2 Megabytesor above in size.If you don’t already have one, this is a great opportunity to create a professional photo to be used elsewhere in your career.This is meant to be a professional headshot photo, so please avoid group photos.Please do not crop the original photo to make it a headshot—APTA staff will do this.
  1. Resume: Please include a resume (two-page limit)as a separate
  1. Interview: Please set up a SkypeOR GoogleChat/Gmail account for avideo interview with the Nominating Committee in mid-July.Once established, please include yourSkype usernameOR Gmail contact info in the space below.Whatever you provide will be used for the interview session.

Username/contact info:______