AAPCA1 Board Position Application Form

Thank you for your interest in nominating yourself to be a part of our American Academy of Pediatrics California Chapter 1 Board and Leadership.

If you have any questions about the position or application, please do not hesitate to contact us at info@aapca1.org.

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* 1. Please provide the following information:

Full name including credentials

Personal Pronouns

Title

Institution/Practice

County of workplace

Personal email address

Phone Number

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* 2. I understand that I must be a member of the chapter to serve on the board. (If you are not a member, you may join the chapter here: https://aapca1.org/membership/)

Yes, I understand.

No, I don't understand.

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* 3. Please select the position you are applying for.
(You may view our geographic breakdown here: https://aapca1.org/about/)

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* 4. Please provide a ballot-ready narrative describing your interest in the selected leadership position, your qualifications, and any specific contributions you would like to make to the chapter (200 word limit).

NOTE: This response will be added to the election ballot sent to our members

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* 5. Please describe experiences that you have with fostering diversity, equity and inclusion in a professional setting. (2-3 sentences)

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* 6. Please provide a short bio. (1-2 short paragraphs suggested)

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* 7. Attach your CV.

(You may also email it to info@aapca1.org after submitting this application if you cannot upload one at this time.)

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* 8. Attach a professional headshot of yourself.

NOTE: This picture will be added to the election ballot.

(You may also email it to info@aapca1.org after submitting this application if you cannot upload one at this time.)