NCPTA 2015 CANDIDATE BIOGRAPHICAL DATA FORM Please complete the following information and return the form to the NCPTA office via:

Email: ncpta@ncpt.org or Fax: 919-841-0269 CANDIDATE NAME: ______________________________________________________________ Candidate for NCPTA Position: ____Treasurer (3 year term) ____Director at Large Education (3 year term) ____House of Delegates (Elect 4 for 2 year terms and 2 alternates for 1 year term) ____Chief Delegate (3 year term) ____Nominating Committee (elect one for 3 year term) ____Scholarship and loan (elect 2 for 3 year terms) ____PTA Caucus Rep and Alternate (Elect 1 and one alternate for one year term) Previous NCPTA/APTA Involvement/Relevant Experience: _______________________________ ______________________________________________________________________________ ______________________________________________________________________________ Reason(s) for Pursuing This Position (40 words or less) ______________________________________________________________________________ What Contributions to the Position Will You Make (40 words or less): _____________________ ______________________________________________________________________________ PT(A) Education (40 words or less): ______________________________________________________________________________ Current Employer: ______________________________________________________________

Thank you for your interest and good luck! NCPTA Nominating Committee

A Chapter of the American Physical Therapy AssociationPhone: (919) 841-0268 Toll Free: 1-800-948-2672 Fax: (919) 841-0269

Email: ncpta@ncpt.org

2015 NCPTA Chapter Election Schedule

TREASURER Three-year term; active (PT) member in good standing. Signatory on Chapter accounts, oversees investments, ensures the fiscal health and approves check-write submissions (26 times a year). Coordinates and attends the annual peer review financial audit by the Finance Committee. Prepares reports for the Executive Committee and Board of Directors meetings and the semi-annual chapter business meetings. As a voting member of the Executive Committee and Board of Directors, attending those meetings is expected. CHIEF DELEGATE

Three-year term; active (PT) member in good standing. Responsible for communicating the related information to the Chapter’s delegates, presents RCs to the membership for appropriate direction during the Spring Business meeting, and serves as the on-site contact throughout the House of Delegates. Prepares reports for the Board of Directors meetings and the semi-annual chapter business meetings. As a voting member of the Board of Directors, attending those meetings is expected. DIRECTOR-AT-LARGE, CONFERENCE Three-year term; active (PT) member in good standing. Responsible for coordinating the chapter’s Spring business meeting and annual Fall event with educational sessions and exhibits. Acts as the liaison for the chapter’s Exhibits committee. Prepares reports for the Board of Directors meetings and the semi-annual chapter business meetings. As a voting member of the Board of Directors, attending those meetings is expected. NOMINATING COMMITTEE MEMBERS Nominating Committee: Three-year term; active or life member in good standing. Assists the Committee chair with the preparation of the chapter’s slate of nominees for NCPTA positions for presentation to the membership at the Fall Chapter Meeting. SCHOLARSHIP & LOAN COMMITTEE MEMBERS NCPTA Scholarship & Loan Fund, Inc. : Three-year term; member of NCPTA in good standing. This organization, separate from the chapter, awards scholarships and loans (emergency and long term) to students in PT and PTA programs, administers the Founders Fund Scholarship; and prepares reports for the Board of Directors meetings and the semi-annual chapter business meetings. PTA CAUCUS REPRESENTATIVE AND ALTERNATE All physical therapist assistant members of APTA are also members of the PTA Caucus, a component and membership grouping of APTA House of Delegates. The PTA Caucus is governed by an elected Board of Directors, all of whom are available to discuss issues affecting the PTA Caucus and the physical therapist assistant.

A Chapter of the American Physical Therapy AssociationPhone: (919) 841-0268 Toll Free: 1-800-948-2672 Fax: (919) 841-0269

Email: ncpta@ncpt.org

2015 NCPTA Chapter Election Schedule Qualifications

Only affiliate, life affiliate or retired affiliate members in good standing who have been members of the PTA Caucus for at least one (1) year immediately preceding their election, or selection, and who have consented to serve are eligible to serve as PTA Caucus representatives.

Primary Responsibilities Participate in sessions of the PTA Caucus at the APTA House of Delegates. CHAPTER DELEGATE 1. Elected during the fall annual Chapter business meeting when needed. 2. Serves a term of two (2) years. Eligible for re-election to any number of additional 2 year terms. Alternate delegates will be elected for one (1) year terms. 3. Assumes office at the close of the Chapter meeting at which (s)he was elected. 4. Reports directly to the Chapter’s chief delegate. A. DUTIES

Represents the opinions and voting wishes of the Chapter (including a minority opinion) at the annual

APTA House of Delegates (HOD). Participates in the Chapter delegation, responsible for serving as a conduit of information between the

NCPTA membership and APTA. Attends delegation meetings before, during and after the HOD. Communicates with Chapter members and other chapter/component delegates regarding policy and

HOD activities. Documents the HOD voting records and submits them to the Chapter’s chief delegate at the conclusion

of the event. Commits to remaining informed of the Chapter’s position on HOD issues. Attends the Chapter’s spring and fall Issues Forums and business meetings. Seeks out member opinions on related and communicate them to the Chapter’s chief delegate. Attends all caucuses, interviews and meetings in which the Chapter’s delegation participates Secures their travel to and lodging at the HOD. Registers prior to the start of the first session of the HOD. Reports any changes to plans or inability to attend any of the meetings to the Chapter’s chief delegate. Ensures the policy for instructing Delegates to the House of Delegates is adhered to. Brings these materials to the HOD:

o APTA Membership card o Delegate registration card o APTA bylaws o HOD handbook with printed motions and other pertinent documents o APTA candidate information

A Chapter of the American Physical Therapy AssociationPhone: (919) 841-0268 Toll Free: 1-800-948-2672 Fax: (919) 841-0269

Email: ncpta@ncpt.org