Diversity, Equity, and Inclusion Activity Report Form for the Physical Therapy Community

The purpose of this form is to gather information about ongoing efforts to increase diversity, equity, and inclusion ("DEI") in the physical therapy community. The process involves completing an online questionnaire that will take approximately 10-15 minutes.  Please submit one form per activity.

Your participation is voluntary. The questionnaire will ask for identifying information like your name and email address, but APTA will not share that information with third parties. APTA may use such information to track progress and to follow up with you in the future about DEI efforts. 

By completing and submitting the questionnaire, you give APTA the right to use and share the information you provide (except for your personal identifying information) with third parties upon their request.