Maine Prevention Certification Board Member Application

Application for Maine Prevention Certification Board Members

The Maine Prevention Certification Board (MPCB) is a peer-led nonprofit organization, serving and representing prevention professionals under the sponsorship of AdCare Educational Institute of Maine, Inc. The certification board is committed to setting, monitoring, and enforcing standards for Alcohol, Tobacco and Other Drug (ATOD) prevention professionals to ensure the public’s protection and enhance the profession. The board is a proud member of the International Certification & Reciprocity Consortium (IC&RC), which establishes standards and facilitates reciprocity for the credentialing of prevention professionals.

The MPCB is seeking board members and would like to invite you to apply. The MPCB aims to have a diverse board represented by not only varying positions and experience levels, but also by geographic locations from around the state. Currently, the MPCB convenes for meetings on the 4th Thursday of the month from 2:30-4:00pm, in Augusta. There is a call-in option available to members who cannot make the meeting in person.

Below is an application which individuals can complete to indicate their interest in being considered to serve on this volunteer Board and to provide information that will aid in the selection process.

Thank you,

The Maine Prevention Certification Board

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* 1. Contact information

Name:

Organization:

City/Town:

Email Address:

Phone Number:

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* 2. Briefly describe your prevention experience (counting both paid and volunteer work) to include, but not limited to, your experience with substance use prevention, commercial tobacco use prevention, public health, teaching, and/or counseling:

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* 3. Please tell us about your higher education completion by inputting your program of study for each degree issued (i.e., Social Work or Psychology or Nursing, etc.):

Associates Degree:

Bachelors Degree:

Masters Degree:

Advance Graduate Degree:

Other Degree(s) from an accredited institution of higher education:

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* 4. Please list any professional certifications or licenses you hold, including the Prevention Specialist (PS-C) certification, if applicable.

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* 5. Are there any other professional education/training/certificates/honors which you have that you feel would enhance your ability to serve the Board and/or represent the Maine substance use prevention field?

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* 6. Please tell us about any previous or current Board or professional leadership role you have had: (Organization, role or position, timeframe)

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* 7. Please indicate which of the following skill sets and experience you have to aide us in board diversity: (Please check all that apply)

Finance, accounting

Personnel, human resources

Administration, management

Nonprofit experience

Community service

Policy development

Program evaluation

Public relations, communications

Education, instruction

Special events

Grant writing

Fundraising

Outreach, advocacy

Other (please specify)

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* 8. Please list any groups, organizations, or sectors that you could serve as a liaison with in regards to substance use prevention specialist credentialing in Maine.

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* 9. Why are you interested in volunteering as a Board member of the Maine Prevention Certification Board?

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* 10. Is there anything else you would like to share with us?

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* 11. To support your application, the MPCB requests that you please upload a copy of your Resume/CV. You may also send it via email to info@mainepreventioncertification.org, Attn: MPCB Administrator.

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