Consent to Serve & Biographical Sketch

Consent to Serve

Your name has been submitted to the Nominating Committee as a potential candidate for election to office in the APTA MN Board of Directors NOTE: Qualification to serve in an elected position in the Minnesota Chapter: According to APTA MN Bylaws, the candidate must have been an “association member in good standing for no fewer than two years immediately preceding (the election)… and are currently… a member of APTA MN. The Nominating Committee prefers that candidates have at least two years service on a APTA MN Chapter Committee, Task Force, or Key Contact involvement. Please confirm your eligibility and willingness to serve by reading this statement, filling out the form and signing below: "I am a member in good standing for the last two years and, if elected, I will fulfill the responsibilities as outlined in the attached job description.”

Name(Required)

First Last

Nominated Position

VP - Engagement

Secretary

PT Director

Delegate

Nominating Committee

APTA Member ID#(Required)

Email Address(Required)

Phone

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please indicate other positions in which you might be willing to serve:

Signature: Please confirm your eligibility and willingness to serve by reading this statement and providing an electronic signature: "I am a member in good standing for the last two years and, if elected, I will fulfill the responsibilities as outlined in the job description.”(Required)

Biographical Sketch

Please list your qualifications for the office for which you are a candidate. Include years where appropriate. Please be thorough, but concise. The Nominating Committee reserves the right to edit for publication, based on length of sketch.

Office for which you are a candidate:(Required)

How long have you been an APTA MN Member?(Required)

What APTA positions have you held and what year?

Other state chapter involvement:

Other involvement in PT (not associated with APTA or APTA MN)

Education (please list your professional credentials)(Required)

Work Experience (List current job title/experience first)(Required)

Publications

Awards / Certifications received in the PT field:

Candidate Essay - Please describe in 250 words or less why you are interested in serving APTA MN in a leadership role. What qualifications do you bring to the position you're running for? What are you looking to accomplish?(Required)

Please upload a headshot for the ballot(Required)

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 2 GB.

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2026 APTA MN Consent to Serve & Biographical Sketch

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(612) 217-1395

PO Box 459 Tolland, CT 06084

info@mnapta.org