Skip to content
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.
*
1.
Please choose the appropriate seat
(Required.)
Athy MD Seat
Naas MD Seat
Community and Voluntary Seat
Social Inclusion Seat
*
2.
Nominating Organisation
(Required.)
*
3.
Details of Nominee
(Required.)
Name
*
Address
Email Address
*
Phone Number
*
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
(Optional) The image supplied will be included in the voting ballot
Choose File
No file chosen
*
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
*
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
