2023-2026 Assembly of Student Delegates Nomination Form

Assembly of Student Delegates Nomination Form

Please fill out this form and submit it by February 28, 2023 at 6:00 p.m. (PST). Late and incomplete submissions will not be considered.
Your Name and Credentials*

First NameLast NameCredentials
Your Professional Membership (Name of WFMT Full Organisational Member or Individual WFMT Member)*
Your Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Your Email Address*
Your Candidate's Name (Note: Candidate must be a member of WFMT [as part of a member organization or an individual member]).*

First NameLast Name
Candidate's Student Membership (Name of Student Organization aside from WFMT membership)*
Candidate's Student Information*
University
Undergraduate studentGraduate student
Academic Year
Expected graduation
Candidate's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Candidate's E-mail*
Rationale for nominating your candidate (maximum of 250 words).*
Verification: By submitting this form, I assure that the nominated candidate*

is enrolled in a recognized music therapy training program (now and at the time of appointment).is informed about this nomination and agrees to serve on the 2023-2026 WFMT Assembly of Student Delegates should he or she be appointed.
Date

MonthDayYear
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