PT/PTA Clin Ed Glossary Term Proposal Question Title * 1. Name of individual proposing edit(s)/addition to CE Glossary: Question Title * 2. Preferred email address for contact regarding submission Question Title * 3. Professional credentials/designation Question Title * 4. Licensure: PT or PTA PT PTA other Question Title * 5. PT/PTA Licensure State (or n/a) Question Title * 6. Clinical education role(s)--Check all that apply SCCE DPT clinical instructor PTA clinical instructor DPT DCE DPT Asst/Assoc DCE PTA DCE/ACCE DPT academic faculty PTA academic faculty DPT academic administrator PTA academic administrator Clinical facility administrator DPT student PTA student other Question Title * 7. Professional affiliation(s)/Representative organization(s) (check all that apply) APTA CESIG APTA PTAESIG ACAPT Clinical Education Commission Other Question Title * 8. Proposed Term: Question Title * 9. Request type: New term Edit(s) to an existing term Question Title * 10. Proposed Definition: Question Title * 11. Justification/Rationale: Question Title * 12. References: see rubric Question Title RUBRIC for CE Terms Suggested Additions/Edits--for reference only Question Title Done