CTAHPERD STUDENT REPRESENTATIVE

CTAHPERD Student Representative Application Form 2009-2010 Send completed application by October 1, 2009 along with a letter of recommendation from a college/university professor.
Connie Kapral CTAHPERD Executive Director 563 Miller Road South Windsor, CT 06074 Questions? ckapral©ctahperd.org Telephone & Fax: 860.644.9206
*Required Information
I am interested in serving as: Student Representative Student Representative Elect
Full Name: *
College/University Attending: *
Expected graduation date: *
Major: *
CTAHPERD Membership Number: *
School Address: *
School Telephone: *
E-mail Address: *
Home Address (include street, city, state, zip: *
Home Telephone: *
College/University Activities: Provide a brief (100 word) statement of interest
Enter the Access Code: