Request edit access
Washington State RPT™ Award Nomination Form
Nominate a WA4PT member and Washington State Play Therapist for "Giving Back" to the Community. 

Do you know a WA4PT member, play therapist or Registered Play Therapist™ that is always giving their time and resources back to the community? This award is given annually to one Washington State WA4PT member that stands out for donating their time, financial resources and/or educational experience to communities in need. 

Minimum Criteria:
  • WA4PT member in good standing
  • Hold a clinical or education license and is credentialed or is working towards credentialing as RPT™, RPT-S™ or SB-RPT™
  • Demonstrates a commitment to "giving back" to the community including children and families
  • Must have a minimum of two members nominating. No self-nominations allowed.
  • Nominations due by 12/15/2024
  
Sign in to Google to save your progress. Learn more
Email *
Nominations are open to Wa State RPT™'s only
Please give us the name of the play therapist you are nominating: *
Please give us the nominee's email and/or phone number so we can reach out if they are awarded:
*
Please tell us why we should choose this person for this award:
*
In the event we need to reach out for further information, please provide us your contact email and/or phone number: 
(Due to the rules of our nominations we do not allow anonymity.)

 
*
Are there any additional details you would like to share?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Whitsitt Family Therapy, PLLC.

Does this form look suspicious? Report