ORTHOPEDIC PT RESIDENCY

ORTHOPEDIC PHYSICAL THERAPY RESIDENCY

Thank you for taking your first step towards clinical excellence. Please complete all components of this form in order to avoid delays in the review process. Please ensure you have also completed the additional application through RF-PTCAS.
First Name *
Middle Name
Last Name *
ADDRESS *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
PREFERRED EMAIL *
Phone Number *

Area Code Phone Number
EMPLOYER *
APTA MEMBER NUMBER (if available)
YEARS of EXPERIENCE *
If student, please indicate anticipated graduation date:
REFERRAL SOURCE *

IAR FACULTY / STUDENT IAR WEBSITE APTA / TPTA E-NEWSLETTER SOCIAL MEDIA
IF REFERRED BY AN IAR FACULTY / STUDENT, PLEASE IDENTIFY THIS INDIVIDUAL
PLEASE INDICATE WHICH RESIDENCY TRACK YOU ARE CONSIDERING. PLEASE RE-VISIT THE RESIDENCY PAGE FOR DETAILED DESCRIPTION OF BOTH TRACKS. *

PART - TIME / INDEPENDENT RESIDENT FULL - TIME RESIDENT / NETWORK (HOUSTON, TX) FULL - TIME RESIDENT / NETWORK (SAN ANTONIO, TX) FULL - TIME RESIDENT / NETWORK (DALLAS, TX) FULL - TIME RESIDENT / NETWORK (AUSTIN, TX) FULL - TIME RESIDENT / NETWORK (CHARLOTTE, NC) FULL - TIME RESIDENT / NETWORK (WEST PALM, FL)
BRIEFLY TELL US WHY YOU ARE INTERESTED IN BEING PART OF THE IAR TEAM. ANY INTERESTING FACTS ABOUT YOU THAT MAY HELP US DURING THE REVIEW PROCESS IS GREATLY APPRECIATED. *
Should be Empty:

ORTHOPEDIC PHYSICAL THERAPY RESIDENCY