Thank you for taking the time to nominate a fellow PT or PTA! A copy of your letter will be sent to the therapist to notify them of the nomination.  If your nominee wins the award you will be invited as a guest to the awards ceremony in April 2024 to support them as they receive the award in person.

Nominations may be submitted by any APTA Wisconsin member except for the Clinical Instructor of the Year which may be submitted by an Academic Coordinator of Clinical Education, a Clinical Instructor or a student.

All materials must be received in the Chapter office by January 31 for consideration for the award in the following year. Submitted materials will not be returned.

Nomination form
Support statement from nominator
Optional: Two letters of support
Optional: CV of nominee

Current members of the Awards Committee shall not nominate; write letters of support, or endorse members for these awards.

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* 1. Nominator's Contact Information

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* 2. Nominee's Name and Contact Information

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* 3. Nominee's Inclusive Dates of Membership

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* 4. Award Recommended For (Award descriptions can be found at https://aptawi.org/about-wisconsin-physical-therapy/awards/)

Please use either option below to submit your support statement and letters of support. 

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* 5. Support Statement, Letters of Support and CV (Type or Copy & Paste Option)

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* 6. Support Statement (Upload Option)

PDF, DOC, DOCX file types only.
Choose File

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* 7. Letter of Support - Optional (Upload Option)

PDF, DOC, DOCX file types only.
Choose File

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* 8. Letter of Support - Optional (Upload Option)

PDF, DOC, DOCX file types only.
Choose File

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* 9. Nominee CV - Optional (Upload Option)

PDF, DOC, DOCX file types only.
Choose File

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