563 Miller Road, South Windsor, CT 06074

Student Representative Application

Executive Council

CTAHPERD Student Representative Application Form 2017-2018

Send completed application by July 1, 2017 Questions? Email: ckapral@ctahperd.org / Telephone & Fax: 860.644.9206

Step 1

Send a letter of recommendation from a college/university professor.

Connie Kapral
CTAHPERD Executive Director
563 Miller Road, South Windsor CT 06074

Step 2

Please fill in and submit the form below

I am interested in serving as a
Student RepresentativeStudent Representative Elect

Your Full Name

College/University Attending

Expected Graduation Date

Major

School Address

School Telephone

Your Email

Street

City

State

Zip Code

Home Telephone

College/University Activities: Provide a brief (200 words) statement of interest

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Fall Conference Registration

Sponsor of TOY Program
Sponsor of TOY Program