2022 COLLEGE STATE DELEGATE APPLICATION

Thank you for your interest in serving as a College State Delegate for the House of Delegates (HOD). Diversity and experience in governmental, political and advocacy groups is what makes our organization great. Below are questions and information that help the College leaders know who you are and what experience you have or could bring to representing our members in the best manner. Serving as a delegate is an important way to support our members and ensure the allergy specialty continues.

Please keep the following in mind:
* You must be an active College member to apply.
* Delegates serve for five-year terms.

Delegates from each state will be chosen by College leadership to strengthen our advocacy network. They will serve as the liaison between local, state and regional allergy societies and the Advocacy Council. Delegates will monitor local legislation; establish contacts with local and state legislators, allergists and regional allergy societies. They will share advocacy information with HOD leaders, super-delegates and Advocacy Council leaders. More details are available at https://college.acaai.org/college-delegate-job-description/

Please complete the following application form. Applications are being accepted Jan. 15 – Feb. 28, 2022. All submitted applications will be vetted by the HOD’s Nominating Committee; one representative from each state will be chosen for a five-year term. All applicants will be notified of their status by June 1.

We are looking for state delegates from Delaware, Hawaii, Idaho, Iowa, Massachusetts, Minnesota, Mississippi, Montana, Nevada, New Hampshire, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Utah, Vermont, Washington, and Wyoming.

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* 1. Please provide your name and contact information.

Last Name

First Name, Middle

Email Address

Cell Phone Number

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* 2. Where do you practice? (If you have more than one office, list your main office.)

City/Town

State/Province

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* 3. How many years have you practiced in this state?

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* 4. Are you Board Certified in allergy?

Yes

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* 5. Are you a practicing allergist?

Yes

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* 6. What issue(s) are you passionate about?

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* 7. List your relationships with: (organization names)

Political organization(s)

Community organization(s)

State medical society

Lobbyist

Local allergy society

Regional allergy society

State allergy society

2022 COLLEGE STATE DELEGATE APPLICATION

Question Title

* 1. Please provide your name and contact information.

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* 2. Where do you practice? (If you have more than one office, list your main office.)

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* 3. How many years have you practiced in this state?

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* 4. Are you Board Certified in allergy?

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* 5. Are you a practicing allergist?

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* 6. What issue(s) are you passionate about?

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* 7. List your relationships with: (organization names)

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* 8. Have you held leadership positions with any of the above organizations/societies?

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* 9. List your relationships with: (name/relationship)

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* 10. Describe your prior advocacy-related work; include grassroots advocacy:

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* 11. List relevant accomplishments:

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* 12. Briefly explain why you want to be a state delegate: