Student Liaison to the MSRC Board of Directors Application

Student Liaison to the MSRC Board of Directors Application
Applicant Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
AARC Member Number*
Respiratory Care Program*
Expected Date of Graduation*

MonthDayYear
Date
Current GPA*
Why do you want to be a Respiratory Care Practioner?*
Why is the MSRC important to Missouri Respiratory Care Practitioners?*
Why do you feel you would be a good student liaison to the MSRC BOD?*
In what way would the MSRC benefit from selecting you as one of the student liasisons?*
As a student liaison to the MSRC Board of Directors, what goals would you work to achieve during your appointment?*
Should be Empty: