AAPA2 - House of Delegates Volunteer Form

AAPA HOUSE OF DELEGATES VOLUNTEER FORM

Note: All positions below require attendance at the HOD meeting being held in Denver, CO from May 16-18, 2025.

I would like to volunteer for (check all that apply):

Reference Committee Chair (deadline of January 10)

Reference Committee Member (deadline of February 14)

Reference Committee Secretary (students encouraged to volunteer) (deadline of February 14)

Credentialing Committee Member (deadline of February 14)

HOD Mentor (deadline of February 14)

Teller (students encouraged to volunteer) (deadline of May 2)

Elections Committee Member (must be a delegate) (deadline of February 14)

First Name *

Last Name *

Constituent Organization:

Constituent Organization: (if you belong to multiple COs)

PA Program & Graduation Date (only current students answer this question)

City: *

State: *

Home/Cell Phone: *

E-mail: *

Are you currently serving as a chair or member of any AAPA leadership group (commission, work group, etc.)? *

Yes

No

If yes, please identify the group

Are you a delegate for the 2024-25 leadership year?
*

Yes

No

Past House of Delegates Experience:

House of Delegates Service Experience:

	Year	Year	Year	Year	Year
Delegate (or Extra Delegate)	Year	Year	Year	Year	Year
Reference Committee Chair	Year	Year	Year	Year	Year
Reference Committee Member	Year	Year	Year	Year	Year
Reference Committee Secretary	Year	Year	Year	Year	Year
Credentialing Committee Member	Year	Year	Year	Year	Year
HOD Elections Committee Member	Year	Year	Year	Year	Year
Teller	Year	Year	Year	Year	Year
HOD Mentor	Year	Year	Year	Year	Year

Please provide brief statement of interest for the position(s) you are volunteering for: *

Please list any special requirements you may have below:

Please upload a copy of your CV *