NCCPA PA Ambassador Form

Apply to Become a PA Ambassador & Make an Impact!

Become a PA Ambassador

PLEASE NOTE: All applicants will undergo an audit to verify their certification status and ensure they are in good standing.

Video Submission (Required)
Please submit a short video (10–30 seconds) introducing yourself. In your video, include:

  • Your name
  • Your specialty
  • Your location
  • Why you love being a PA

Here's an example script: Hi, I’m Alicia Quella. I’m a Board Certified PA who works in administrative medicine in Minnesota and the best part of being a PA is I get to travel and meet a lot of people."


Upload your video below. File size must be 100 MB or less. After clicking Submit, wait for the confirmation message before exiting the page. If you encounter any issues, email [email protected].

The application window for our upcoming cohort is now closed.

We appreciate your interest and encourage you to stay connected with us for updates on future opportunities.