Online Recommendation Form for Office

MEMBER RECOMMENDED
First Name
Last Name
Designation (i.e. PT, PTA)
Email
Telephone
District
 
STATE LEVEL
The above member is recommended for the position of:
Primary State Elected Positions
Committee Chair (name a committee)
 
DISTRICT LEVEL
Primary District Elected Position
Additional District Elected Position
 
Type of Recommendation
 
 
PERSON COMPLETING THIS RECOMMENDATION FORM (must be an OPTA member)
First Name
Last Name
Designation (i.e. PT, PTA)
APTA Member ID
District
Address
City
State
Zip
Phone
Email
 
 
QUALITIES EXEMPLIFIED
Please identify one or more qualities that you believe this recommended individual exemplifies
 ArticulateResponsibleConsensus Builder
 VisionaryResolves ConflictPersuasive
 OrganizedParliamentary KnowledgeLeadership Experience
 CreativeExcels in CommunicationTechnology expertise
Other Qualifications
 
   - denotes required fields