Request PT Moves Me Presentation

Thank you for your interest in having a physical therapy representative speak with your program or class. Please complete the information below in as much detail as possible. APTA staff will work to connect you with a physical therapy professional to serve as a speaker for your request. If you have any questions please reach out to studentrecruitment@apta.org.

Please submit this form at least four weeks prior to the date a physical therapy representative is needed. APTA does not guarantee a representative; however, we will do our best to ensure that requests submitted a month prior to the date needed are fulfilled.

Prefix

First name

Last name

Credentials

Position

Title

School/Company/Organization

Address

City

State

Zip

Contact phone

Contact email

Name of program, or school where you’d like staff to speak

Target Audience Age Range

Expected Size of Target Audience

Date(s) you are requesting

Time you are requesting (in EST)

Type of event (Virtual, In person, Hybrid, Other)

If other please describe

Brief Description of program or class objective

What area of the profession of physical therapy would you like to focus (select all that apply) General knowledge about the profession (including PT and PTA) General knowledge about being a physical therapist General knowledge about being a physical therapist assistant Applying to DPT programs Applying to PTA programs Physical therapy specialty areas Physical therapist assistant advanced proficiency pathways Career options within the profession of physical therapy Other

If other please describe

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