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Criteria: (one or more must apply)
Nominee's Name
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Full Mailing Address
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E-Mail Address (year-round)
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Phone (year-round)
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Place of Employment
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Address of Employment
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Start Date of Employment
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Supervisor Name, Title
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Letters of Recommendation/Support
Write a brief statement on how this program meet: (1) Shows commitment to the Adapted Physical Education profession by having served at the local, state, regional, and/or national level and/or having presented topics related to Adapted Physical Education at conferences or workshops. (2) Serves as a positive role model. Exhibits enjoyment of activity and exemplifies sensitivity to the needs of individuals with disabilities. (3) Has made significant contributions to physical education for individuals with disabilities at the local, state, regional or national level. (4) Has contributed significantly to the area of Adapted Physical Education or related areas. (5) Has made a significant mark in the lives of others through teaching, athletics, entertainment, serving in public office, or in some other way enhancing the positive image of individuals with disabilities in society.
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Form completed by name, email address, phone
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