APTA Washington Award Nomination Form

Who would you like to nominate for an Award?

Your nominee's name

Your nominee's email address

Your nominee's phone number

Choose an Award

To be eligible, nominees must be PTWA members (except for Joseph Black Friend of PT Award). To reread the criteria, visit: http://aptawa.org/misc/PTWA-awards-criteria

Award for Clinical Excellence

Physical Therapist of the Year

Physical Therapist Assistant of the Year

Donna El-Din Distinguished Service Award

Joseph Black Friend of Physical Therapy

Why are you nominating this person?

Award for Clinical Excellence nominees also require that you submit a CV. Please email the CV to erica@aptawa.org.

Please fill out the information below so that we may contact you with any questions.

Contact Information

First Name

Last Name

Work Phone

Home Phone

Thank you for submitting an award nomination. All fields are required to submit this form. If you have questions about submitting a nomination, please contact nominating@aptawa.org.

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