Demographics

First Name *

Last Name *

Email *

Preferred Phone *

Address *

City *

State *

Zip Code *

Credentials *

CTRS

LRT

FDRT

PhD

EdD

MS

MA

Other

Other Credentials not Listed:

Which board position would you like to be considered for? *

President-Elect
Treasurer
Member-at-Large
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Number of years as an ATRA member *

Contributions to ATRA

In these next sections, we would like you to list the service(s) that you have provided to ATRA. Please include all positions and service that you have engaged in over the years.

Position(s) Held *

Year(s) *

Responsibilities *

Outcomes *

Contributions to the Profession

In these next sections, we would like you to list the service(s) that you have provided to the profession. Please include all positions and service that you have engaged in over the years.

Positions/Service

Duration

Responsibilities/Experience

Outcomes/Take Aways

What do you consider to be your most valued contribution to ATRA and/or the profession?

Why are you interested in serving on the ATRA board of directors? *

Recommendation and Resume

Please attach and upload one recommendation letter. *

Please attach and upload an updated copy of your resume or CV. *