19 N. Riverside Ave. P.O. Box 320, Terryville, CT 06786

Student Representative Application

Executive Council

CTAHPERD Student Representative Application Form 2020-2021

Send completed application by July 1, 2022 Questions? Email: galske@ctahperd.org

Step 1

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

Lisa Galske
CTAHPERD Executive Director
P.O. Box 320, 19 N. Riverside Avenue, Terryville, CT 06786

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