APTA NH Awards Nomination 2026

Please complete this form to submit a deserving member for an award

Individual is being nominated for the following APTA NH Award:

Granite State Distinguished Physical Therapy Service Award

Granite State Distinguished Physical Therapy Clinical Excellence Award

Name of applicant (please include all credentials):

Email of Applicant:

Current Employer of applicant:

Name of person submitting

Email of person submitting

Service Award

5 years or more of APTA NH membership / Currently a NH licensed PT or PTA who has / Provided exceptional service to APTA NH community / Advanced the profession of physical therapy

List of Nominees service, volunteer positions in APTA NH, APTA National or the Physical Therapy profession

In 500 words or less, describe the Nominee's contributions to APTA NH and the profession

Clinical Excellence

5 years or more of APTA NH membership / Currently a NH licensed PT or PTA who: possesses a strong sense of pride for serving patients and the community and Consistently provides exceptional patient experiences and clinical outcomes

List of Nominees service as a mentor to the physical therapy community (clinical instructor for students, mentor for new staff, in-service presenter, etc.)

In 500 words or less, describe the Nominee's contributions to patients and the community

857-702-9915
PO Box 459
Tolland, CT 06084
nhapta@libertysquaregroup.com