Philippine Association of Orthopedic Manual Physical Therapy

2019 Clinical Instructor‐of‐the‐Year Nomination Form

PAOMPT is searching for an exceptional Clinical Instructor in Orthopedic

Manual/Musculoskeletal physical therapy and we want to make our peers aware!

Submit this form to paompt@gmail.com by December 31, 2018 to be considered for the search.
If your nominee is chosen, the contact identified below will be notified mid‐February so awardee
can plan to attend the Annual Conference in July to accept the award. The Awardee is provided
a 50% off on conference registration fee.
Eligibility
• Nominees must be a member of PAOMPT and PPTA.
Nominations
• May be submitted by any PAOMPT/PPTA member.
• Must be submitted in writing using this form.
• Must attach an essay or resume supporting the nomination.

PAOMPT has the right to not highlight the awardee.

Name of Clinical Instructor: City:

What is the name of the Clinic:

What is unique and innovative about your nominee? (On separate sheet)

Submitted by:
Your Email: Phone:

Contact: same as above or

Name:
Your Email: /Phone:

Visit PAOMPT’s website for details on how to be a member.

To be an Annual Conference sponsor, recruiter, or exhibitor, contact send us an email
Paompt@gmail.com www.paompt.org