TF on Rcs 3-11 Through 12-11 Volunteer Form

APTA Volunteer Group Submission Form

Name of Group:RC 4-11 through 12-11 Task Force

Deadline:July 5, 2011

• Member Name and Credentials:

• Member Number:

• Current Chapter:

• Current Section(s):

• Preferred Address:

• Preferred Email:

• Preferred Phone:

• If appointed, please indicate your consent to serve by checking the box below.

□ I consent to serve on the RC 4-11 through 12-11 Task Force

• Please read and respond to one of the statements below.

□ I understand that if appointed to the RC 4-11 through 12-11Task Force the time requirement may be significant and I am willing and able to make the commitment.

□ I am unable to make the time commitment required to serve on the RC 4-11 through 12-11 Task Force.

Specific Requirements for This Group:

1. Please describe your qualifications (e.g., education, work experience, volunteer experience, familiarity with Association policies related to the PT/PTA relationship in practice and education, etc.) to serve on this Task Force relative to the motion adopted by the 2011House of Delegates. Specifically,describe what qualifications you have that will allow you to work successfully with others to accomplish the tasks outlined in A through G below.

NOTE: Please limit your response to no more than 500 words.

*That RC 4-11 through RC 12-11be referred to the Board of Directors to review the current model of the physical therapist (PT), physical therapist assistant (PTA), and physical therapy aide (PT aide) as the only participants involved in delivery of physical therapist services and identify potential models of delivery of these services that:

1. Describe the patients/clients that PT’s manage;
2. Describe the level and complexity of physical therapist management required by these patients/clients;
3. Identify the types of participants that could support the PT in potential new models of service delivery;
4. Are consistent with and promote potential new payment models for physical therapist-directed services;
5. Delineate opportunities and barriers to support the use of those individuals at the appropriate points in the potential new service delivery models;
6. Include strategies to leverage those opportunities and/or reduce those barriers, and;
7. Investigate changes to the educational preparation and scope of work of the PTA.

*Please note that the language listed above is considered draft until the minutes of the 2011 House of Delegates have been reviewed and approved.

Insert response to first question here:

1. Please provide examples of work or volunteer group projects in which you have engaged that demonstrate the list of characteristics below.

NOTE: Please limit your response to no more than 500 words.

A.Passion

B.Commitment

C.Service orientation

D.Character/integrity

E.Positive attitude

F.Dependability

G.Punctuality

H.Ability to relate to others and build relationships

I.Ability and willingness to listen to and learn from others

J.Self-awareness – knowledge of what you know, what you don’t know, when to seek help/answers, strengths/weaknesses etc.

Insert response to second question here: