Database of Potential Leaders for Constituent Organizations

DATABASE OF POTENTIAL LEADERS FOR CONSTITUENT ORGANIZATIONS

The AAPA's Leadership and Professional Development (LAPD) Council connects constituent organizations (state and specialty PA associations) with potential leaders who practice in their state or specialty. If you are interested in constituent organization leadership opportunities, please complete this form. We will share your preferred contact information and a copy of your CV with constituent organization officers in your state or specialty.

First Name

Last Name

AAPA Membership #:

PA Program Attended:

Please choose the constituent organization (s) you want us to notify about your interest in volunteering:

State Organization:

AAPA Caucuses:

AAPA Recognized Specialty Organizations:

Leadership History:
Please complete all that apply to your leadership experience.

PA Organization:

Position:

Year(s):

PA Organization:

Position:

Year(s):

PA Organization:

Position:

Year(s):

Other additional positions you believe would be of interest to the constituent chapter receiving this information.

Preferred contact information (this will be provided to your constituent organization):

Street Address:

City:

State:

Zip Code:

Phone Number:

E-mail:

Please upload your current bio, resume, or CV here or e-mail it to kerb@aapa.org.

* Indicates Response Required