SAAAPA HOD Delegate/Alternate Application

HOD Student Representative Application

Application deadline extended until November 30, 2011

Application information:

The Student Academy has 54 spots for students interested in serving as student House of Delegate (HOD) representatives in Toronto, Saturday, May 26 through Monday, May 28. Students selected for the positions will be assigned to Reference Committee A, B, or C and will be required to attend all of the HOD sessions related to the assigned reference committee, but are also encouraged to attend all sessions of the House. This means that all applicants will be required to attend the annual conference from early Saturday morning (HOD new delegate orientation starts at 7:30am) until the HOD ends on Monday evening and therefore must book their travel in and out of Toronto accordingly.

All applicants will be notified in late October of selection status and applicants who are selected will be responsible for registering to attend the HOD.

Questions regarding HOD registration should be directed to students@aapa.org.

* First Name:

* Last Name:

* AAPA ID#:

* PA Program (School) Attending:

* Anticipated Graduation Date (month & year):

* Phone Number:

* E-mail:

* Reference Committee preference - please rank with the number 1 as your top choice.

	Reference Committee A - Academy bylaws and operations
	Reference Committee B - education, certification, membership, constituencies
	Reference Committee C - professional practice, government affairs, public policy

* Explain why you would like to serve as one of the Student Academy HOD delegates? (Please limit to 500 words or less)

0/500 words

Please read and confirm the following statements:

I have read and agree to the description of student responsibilities.

I will attend the 2012 AAPA Annual Conference in Toronto.

I will be present for the respective HOD Committee hearing and evening meeting.

I will be present for delegate voting on the last day of HOD.

By submitting this application, I understand the requirements for being an HOD student representative. I also agree to arrange my travel so that I can attend all sessions of the HOD.

Additionally, I have discussed this with my program director or faculty and have permission to attend this and represent my PA program and all PA students. A separate form is required and must be filled out by your PA program director or faculty.

Click here to download the Program Director/Faculty confirmation form.

* Indicates Response Required