2019 Steering Committee Candidate Application

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* 1. Contact Information:

Name: *

Organization: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number: *

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* 2. Job Title:

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* 3. Please provide a candidate statement for publication on the Commons, including: (a) Why you are interested in serving on the RE-AMP Network Steering Committee and (b) your history of involvement and collaboration in the Network.”

(We recommend preparing the statement in a separate document then copying and pasting it below.)

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* 4. Please list individuals from three RE-AMP member organizations who will support your nomination

Individual and Organization 1

Individual and Organization 2

Individual and Organization 3