Kildare PPN Secretariat Nomination Form

Kildare PPN are currently seeking nominations to fill a number of vacant seats on the Secretariat. Please fill out the form below to submit a nomination on behalf of your organisation.

Question Title

1. Please choose the appropriate seat (Required.)

Athy MD Seat

Naas MD Seat

Community and Voluntary Seat

Social Inclusion Seat

Question Title

2. Nominating Organisation (Required.)

Question Title

3. Details of Nominee (Required.)

Name *

Address

Email Address *

Phone Number

Question Title

4. Candidate Statement (Maximum 150 words). This will be circulated to member groups ahead of the election . Please state why you may be the most suitable candidate for the role. (Required.)

Question Title

5. Upload Image/Headshot

Question Title

6. This nomination must be authorised by the nominee’s organisation. The Authorised Officer should be the organisation’s Chairperson or Secretary. Please provide the contact email address of the group's Chairperson or Secretary for verification of nomination (Required.)

Name

Position

Email Address

Phone Number

Question Title

7. The information provided in this form will be held by the Kildare Public Participation Network. View Kildare PPN's Private Policy here to see how your data is processed: https://bit.ly/3n6zGnX (Required.)

I Consent

Kildare PPN Secretariat Nomination Form

Question Title

* 1. Please choose the appropriate seat (Required.)

Question Title

* 2. Nominating Organisation (Required.)

Question Title

* 3. Details of Nominee (Required.)

Question Title

* 4. Candidate Statement (Maximum 150 words). This will be circulated to member groups ahead of the election . Please state why you may be the most suitable candidate for the role. (Required.)

Question Title

* 5. Upload Image/Headshot

Question Title

* 6. This nomination must be authorised by the nominee’s organisation. The Authorised Officer should be the organisation’s Chairperson or Secretary. Please provide the contact email address of the group's Chairperson or Secretary for verification of nomination (Required.)

Question Title

* 7. The information provided in this form will be held by the Kildare Public Participation Network. View Kildare PPN's Private Policy here to see how your data is processed: https://bit.ly/3n6zGnX (Required.)

1. Please choose the appropriate seat (Required.)

2. Nominating Organisation (Required.)

3. Details of Nominee (Required.)

4. Candidate Statement (Maximum 150 words). This will be circulated to member groups ahead of the election . Please state why you may be the most suitable candidate for the role. (Required.)

5. Upload Image/Headshot

6. This nomination must be authorised by the nominee’s organisation. The Authorised Officer should be the organisation’s Chairperson or Secretary. Please provide the contact email address of the group's Chairperson or Secretary for verification of nomination (Required.)

7. The information provided in this form will be held by the Kildare Public Participation Network. View Kildare PPN's Private Policy here to see how your data is processed: https://bit.ly/3n6zGnX (Required.)