Please complete the board matrix from in the survey below. If you prefer to review the paper form of questions prior to submitting the survey, please find the Paper Form HERE. If you have any questions, please email Molly Shevlin at mshevlin@hauck.com or Morgan Denault at icomus@icom.museum.

If you are nominating on behalf of someone else, please include a letter of nomination in the additional support information upload

*Note that the committee is taking a long view of shaping the board, so nominations received this year may be considered in future years.*

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* 1. Contact Information:

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* 2. Type of Institution (choose one)

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* 3. Please answer the following questions in regards to your organization or institution (if applicable):

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* 4. Areas of Expertise/Professional Skills (Check all that apply):

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* 5. Demographic Information- Age:

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* 6. Demographic Information-Gender

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* 7. Race/Ethnicity:

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* 8. Geographical Distribution (U.S.):

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* 9. Individual ICOM Members Since (Year Joined):

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* 10. Institutional ICOM Members Since (Year Joined):

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* 11. List your language skills and proficiency below:

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* 12. ICOM-US Board Service Interest:

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* 13. (Self Support) Ability to self-finance participation in annual meetings and international committee meetings

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* 14. (Institutional Financial Support) Ability to receive support to participate in annual meetings and international committee meetings:

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* 15. Past Board Experience: Please list your experience in working on Boards below:

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* 16. ICOM Experience: List your ICOM experience (international, national, technical committees and positions held):

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* 17. International Experience: Tell us about your experience working on international project, collaborations, employment, conference attendance and travel:

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* 18. Please upload a short bio (or paste in the comment box below):

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* 19. Please provide a short bio below (or upload in the previous question):

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* 20. Other Comments:

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* 21. Additional support information (optional upload):

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