A Chapter of the American
Physical Therapy Association


 
 
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PTWA Award Nomination Form
 

Award nominations may be submitted at any time during the year; nominees will be included in the next round of consideration immediately following each deadline.

Awarded at a Spring Conference breakfast awards ceremony on Saturday morning
Deadline: February 15
    Physical Therapist of the Year
    Physical Therapist Assistant of the Year
    Distinguished Service Award
    Award for Clincal Excellence


Awarded during the Fall Chapter Meeting
(Service awards also presented to volunteer leaders completing terms of service also take place during the Fall Chapter Meeting and do not require a nomination.)
Deadline: August 15
    Joseph Black Friend of Physical Therapy (does not need to be a member)

Guidelines for submitting nominations:
    Please consult the criteria for each award before submitting a nomination. Criteria may be found at www.ptwa.org/awards.htm.
    Please submit complete information. Incomplete submissions may disqualify your nominee.
    Please verify membership of your nominee before submitting his or her name. Membership can be verifited through APTA's online membership directory.



 
Nominee Name
Nominee Mailing Address

City, State, Zip
Nominee Phone Number
Nominee Email Address
   
Your Name
Your Phone Number
Your Email Address
 
Award for which you are nominating
this person

Deadline February 15, except where noted





(deadline August 15)

   
Please detail how this nominee
meets the award criteria.

Please also submit CV if you are nominating someone for the Award for Clinical Excellence. CV may be emailed to awards@ptwa.org or faxed to 360-352-7298.