2016 Board Member Nomination Application Form

Arkansas Council for Exceptional Children- CLOSES APRIL 18th

Interested leaders may self-nominate or be nominated by those that believe they are a good fit for the leadership position.

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* 1. Nominee Information:

Name

Address

City / Town

State / Province

ZIP / Postal Code

Phone

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* 2. Desired Board Position

Vice President

Awards Chair

Secretary

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* 3. Nomination Method:

Self-Nominated

Nominated by Peer or Colleague

If nominating a Peer or Colleague, please leave your name and email here.

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* 4. Which of the following best describes the nominee's current occupation?

General Education Teacher

Special Education Teacher

Administrator

Higher Ed

Therapist (OT, PT, SLP)

Other (please specify)

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* 5. Employer's Name and Location (if applicable):

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* 6. CEC Membership Status

How many continuous years has the nominee been a CEC member?

CEC Membership Number

Is the nominee a member of any subdivisions? If so, please list.

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* 7. Has the nominee held any previous CEC leadership positions or received any awards/scholarships from CEC? If so, please list below. (Previous participation on the CEC board is not necessary. We welcome all individuals interested in serving.)

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* 8. List any other relevant Non-CEC Professional or Volunteer Leadership Activities

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* 9. Availability: Is the nominee willing to attend all regular AR-CEC Board meetings and fulfill all other obligations if elected?

Yes: An average of 3 meetings yearly, a 1-2 day board retreat, and State Conference

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* 10. Optional Information (This information will not be published, but it helps us to ensure diversity of nominees.):

Gender

Ethnicity

Age Range: 20's, 30's, 40's, 50's, or 60+

Exceptionality

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* 11. Why would the nominee be great for this position? OR Why would you like this position on the AR-CEC Board?

AR-CEC elections will take place May 1st - June 1st, 2016.

ELECTED BOARD MEMBERS MUST ATTEND A REQUIRED BOARD MEETING JUNE 17TH, 2016

(9 a.m. - 12 p.m.) at EMBASSY SUITES in Little Rock.

Email arkansascec@gmail.com if you have any questions.