Student Delegate Application

Name(Required)

First Last

Member ID(Required)

Designation(Required)

School and Graduation Date(Required)

I am qualified to serve as Student Delegate to the Maryland Delegation because (remember to include pertinent leadership experience and involvement in promoting the physical therapy profession):(Required)

If appointed to be a student delegate, 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):(Required)

What has influenced you during your SPT/SPTA experience that has motivated you to want to become involved beyond the classroom?(Required)

Candidate Statement: (please focus on why you intend to run for student delegate, what your strengths are, and what you hope to achieve)(Required)

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Student Delegate Application

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