2017 Board Nomination Form - National Association of Chronic Disease Directors

2017 Board Nomination Form

2017 Board of Directors Member Nomination Form
Submission Deadline
Nominations close July 28, 2016.
Name of Candidate: *
Candidate's Current Job Title:
State/Territory: *
Candidate's Phone: *		Email: *
How long has candidate been in this position? *		How long has candidate worked in public health? *(# of years)
Has candidate served on any other boards? (If yes, please list organization(s) or n/a if no)Add organizations here, one organization per line
Does candidate have any experience with the following? *	Strategic or long-term planning Understanding of financial reports Partnership development/networking
Is the candidate's supervisor supportive of the role and time required of this responsibility? *
Please Describe the Reason for Your Candidate's Nomination

Provide explanation: *	500 of 500 characters remaining
CV Upload: *Upload Nominee's CV Here
Your Name: *Enter Name and email here
Your Phone:
Your Email: *

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