APA Division 19 (Society for Military Psychology)
CAMPUS REPRESENTATIVE APPLICATION
CAMPUS REPRESENTATIVE
CONTACT INFORMATION
PROGRAM & FACULTY SPONSOR
CONTACT INFORMATION
LAST NAME:
SCHOOL/UNIVERSITY:
FIRST NAME:
DEPARTMENT/PROGRAM:
MIDDLE INITIAL:
DEGREE SEEKING:
SUFFIX:
MAILING ADDRESS LINE 1:
MAILING ADDRESS LINE 2:
MAILING ADDRESS LINE 1:
CITY:
MAILING ADDRESS LINE 2:
STATE:
CITY:
ZIP CODE:
STATE:
ZIP CODE:
PREFERRED EMAIL ADDRESS:
FACULTY SPONSOR NAME:
PREFERRED TELEPHONE NUMBER: ( ) -
FACULTY SPONSOR TITLE:
ALTERNATE TELEPHONE NUMBER: ( ) -
FACULTY SPONSOR PREFERRED EMAIL ADDRESS:
YEAR IN PROGRAM:
FACULTY SPONSOR PREFERRED TELEPHONE NUMBER:
( ) -
ANTICIPATED GRADUATION DATE:
GPA:
CURRENT DIVISION 19 STUDENT AFFILIATE? (Y/N):
APAGS MEMBER #:
Check one (1) box below to indicate your desired length of service (Note: Terms begin on
January 1 and end on December 31; it is recommended that Campus Representatives complete
their terms prior to attending internship or other long-term, off-campus training):
☐One-year position
☐Two-year position
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APA Division 19 (Society for Military Psychology)
Instructions: Please answer the questions below to the best of your ability. There are no “right”
or “wrong” answers. Type-written responses are preferred. Be direct and concise.
1. What is the nature of your interest in Military Psychology?
2. List up to three (3) previous leadership roles/activities. Pick one (1), and discuss how the
experience impacted who you are today.
3. In your opinion and/or experience, what makes a great leader?
4. Describe your own leadership style. Identify one (1) area of strength and two (2) areas of
weakness. How do you plan to improve your leadership ability?
5. What unique skills and abilities can you bring to the Div 19 Campus Representative position?
6. How might being a Div 19 Campus Representative impact your future? What relevance
could it hold for your personal goals, education, career, professional development, etc.?
7. Division 19 Campus Representatives are student leaders, and with any leadership role comes
a great deal of responsibility, integrity, and accountability. If selected, what responsibilities
would you have (a) to your peers, (b) to the division, and (c) to yourself. Include one possible
ethical consideration related to the role of Div 19 Campus Representative.
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