Student Society Registration Form - 2008-2009

(valid until 8/31/09)
To be fully registered, a society must submit the list of officers and the current student society bylaws annually. NOTE: According to the Student Academy bylaws, "There may be no more than one student society per program." For more information about membership in SAAAPA, contact Shannon Faherty, Student Academy staff advisor, at 703/836-2272, ext. 3311 or sfaherty@aapa.org.

STUDENT SOCIETY INFORMATION

Name of Student Society

PA Program

School Term (i.e., September 2008 - September 2009)

Student Society Mailing Address

Address Line 2

City

State

Zip Code

Student Society Web site

Faculty Advisor Name

Faculty Advisor AAPA ID Number

Faculty Advisor E-mail

STUDENT SOCIETY OFFICERS

We strongly encourage you to provide e-mail addresses for all officers. Electronic communication is the fastest and most cost-effective means of communication available to most students, therefore the Student Academy relies heavily on e-mail communication and use of the SAAAPA Web site.
To facilitate interaction, rosters of the various positions may periodically be provided to each officer - for example, student society presidents would receive a roster of all other presidents to enable communication and idea swapping.

PLEASE NOTE THAT ACCORDING TO THE SAAAPA BYLAWS,
ALL STUDENT SOCIETY OFFICERS MUST BE AAPA MEMBERS

PRESIDENT: Name

AAPA ID Number

Street Address

City

State

Zip Code

Cell Phone Number

E-mail

VICE PRESIDENT: Name

AAPA ID Number

Street Address

City

State

Zip Code

Cell Phone Number

E-mail

SECRETARY: Name

AAPA ID Number

Street Address

City

State

Zip Code

Cell Phone Number

E-mail

TREASURER: Name

AAPA ID Number

Street Address

City

State

Zip Code

Cell Phone Number

E-mail

CONSTITUENT CHAPTER STUDENT REPRESENTATIVE (CCSR)

This position represents your program to the AAPA constituent chapter on the state level. In states where there is more than one PA program, there may be a selection process determined by the state chapter to choose the student representative. For more information on your state constituent chapter policies, contact your local chapter.

CCSR: Name

AAPA ID Number

Street Address

City

State

Zip Code

Cell Phone Number

E-mail

EXTERNAL AFFAIRS CHAIR (EAC)

This position serves as a liaison to coordinate activities and public relations efforts between their student society and external groups. The EAC shall report all activities to both the SAAAPA Director of External Affairs Senior and Junior. The responsibilities of the EAC should include, but are not limited to the following: Coordinate activities and public relations efforts between the student society and external groups; these groups include, but are not limited to: other medical professionals (MD, DO, PT, OT, nurses, speech, etc.), city organizations, county organizations, state organizations, national organizations, and other community related organizations.

EAC: Name

AAPA ID Number

Street Address

City

State

Zip Code

Cell Phone Number

E-mail

STUDENT HISTORIAN

This position serves as a liaison to coordinate activities between their student society and the Society for the Preservation of Physician Assistant History. The Student Historian shall report all activities to the Society for the Preservation of Physician Assistant History.

Student Historian: Name

AAPA ID Number

Street Address

City

State

Zip Code

Cell Phone Number

E-mail

AOR/HOD/SDCR DESIGNATION

This form must be completed by November 1, 2008, to ensure that your student society receives all information pertaining to student society representation at the AAPA's 37th Annual PA Conference and to be able to register a team for the national SAAAPA Medical Challenge Bowl. The AOR and HOD representatives should be two different individuals as the meetings run concurrently.
For more information, contact Shannon Faherty, Student Academy staff advisor, at 703/836-2272, ext. 3311 or sfaherty@aapa.org. Even if you are unsure about attending the annual conference, we ask that you provide us with an AOR and HOD contact so that your program will be kept up to date on important national activities.

AOR REPRESENTATIVE

This is your program's student representative to the 2009 Assembly of Representatives, the legislative body of the national Student Academy, which will meet May 23-24, 2009, in San Diego, CA, at the AAPA's 37th Annual PA Conference. A student representative is required of every PA program.

AOR: Name

AAPA ID Number

Street Address

City

State

Zip Code

Cell Phone Number

E-mail

AOR ALTERNATE

Each program may also designate an AOR alternate. The AOR alternate will not be allowed on the floor to introduce new business, make a motion or vote unless the seated representative to the AOR relinquishes their seat either temporarily or permanently. The AOR alternate must leave the floor once the seated AOR representative returns. Materials will be sent only to the seated AOR representative who must distribute copies to the alternate and other students within the program.

AOR Alt: Name

AAPA ID Number

Street Address

City

State

Zip Code

Cell Phone Number

E-mail

HOD STUDENT DELEGATE

The student delegation to the AAPA House of Delegates consists of 12 delegates and an unlimited number of alternates. The delegates are chosen by a lottery system and each program may only submit one name for this position. Your program's HOD student delegate will serve as a delegate or alternate (depending on the lottery results for 2009) in the 2009 student delegation which will represent the Student Academy in the AAPA's House of Delegates at the AAPA's 37th Annual PA Conference in San Diego, CA, May 23-25, 2008.

HOD: Name

AAPA ID Number

Street Address

City

State

Zip Code

Cell Phone Number

E-mail

STUDENT DIVERSITY COMMITTEE REPRESENTATIVE (SDCR)

The SDCR serves as the liaison between the Student Academy and the student society regarding diversity issues affecting their classmates as future colleagues and health care providers. The elected individual need not be a minority, but must have a strong interest in supporting and promoting the education of students on issues of diversity. The duties of this office shall include but not be limited to: a. coordinate, with the aid of the regional chair, local activities and community outreach projects; b. provide monthly updates regarding activities at his/her program that serve to promote cultural competency to his/her regional chair.

SDCR: Name

AAPA ID Number

Street Address

City

State

Zip Code

Cell Phone Number

E-mail

STUDENT SOCIETY ROSTER

An electronic copy of your student roster must be submitted annually, per SAAAPA policy SA-A-200.6.2.3, "The student society roster form must be accompanied by the society’s proposed bylaws." The roster should include the name, e-mail address and phone number of each student society member. Please upload your student society roster below. If you are unable to do so, you may e-mail a copy or an attachment to Shannon Faherty at sfaherty@aapa.org.

Student Society Roster 2008-2009

STUDENT SOCIETY BYLAWS

An electronic copy of your bylaws must be submitted annually. Please cut and paste your student society bylaws below. If you are unable to do so, you may e-mail a copy or an attachment to Shannon Faherty at sfaherty@aapa.org.