Fillable Committee/Task Force Sign-up Form (Professional Association of Therapeutic Horsemanship International)

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Committee/Task Force Sign-up Form (Professional Association of Therapeutic Horsemanship International)

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Committee/Task Force Sign-up Form
If you are interested in volunteering for a PATH Intl. committee/task force please fill out this form completely. PATH
Intl. will share your information with appropriate committees and identify opportunities for you to put your skills to use
on PATH International’s behalf. Thank you so much for taking the time to help make a difference!
NAME: PATH Intl. Member #:
Address:
City/State/Zip/Country:
Day Phone: Evening Phone:
Email Address:
Are you 18 years of age?
□ YES □ NO
What committee, region or organizations are you interested in volunteering for?
□
Program and Standards Oversight Committee
□
Membership Outreach Committee, Region____
□ Accreditation Subcommittee
□ Health & Education Advisory
□
Certification Oversight Committee
□
Standards Review Task Force
□
Riding Certification Subcommittee
□
Quality Assurance Task Force
□ Therapeutic Driving Certification Committee
□ International Conference Host Task Force
□
Interactive Vaulting Certification Subcommittee
□ Equine Welfare Committee
□
Regional Conference Task Force
□ State Chair of____________
□
Equine Specialist in Mental Health and Learning
Subcommittee
□
Equine Services for Heroes Committee
□
Other_______________________________
Please circle the following skills you would like to share or interests you have:
□
Accounting
□
Community Leadership
□
Management
□
Training/Mentoring
□ Development
□ Education/Curriculum
□ Publishing
□ Marketing
□
Bilingual
□
Riding
□
Driving
□
Vaulting
□ Evaluator
□ Site Visitor
□
Mental Health/Special Credentials: PT OT SLP Psychologist Doctor
□
Mental Health Experience/Interest
Other:_____________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Have you been convicted of a felony within the last five years?
□ Yes □ No
If yes, please describe, on a separate sheet, the circumstances of your conviction, including the date, nature, and
place of the offense and disposition of the case. A felony conviction will not necessarily bar you from
employment since this will be looked upon as only one of the factors considered in the employment decision
and is evaluated in terms of the nature, severity and date of the offense.
Please attach a cover letter and resume to this form.
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CommitteeTask Force Sign-up Form (Professional Association of Therapeutic Horsemanship International)

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Completed 11 March 2021

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