2017-2019 NCA Regional Sponsor Representative Application

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* 1. Contact Information:

Name:

Company:

Address:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

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* 2. For how long have you been a member of the National CACFP Sponsors Association?

Less than 2 Years

2-5 Years

6-10 Years

Over 10 Years

Other (please specify)

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* 3. USDA Region for which you are applying to serve as representative?

Mid-Atlantic Region (MARO): Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania, Puerto Rico, Virginia, Virgin Islands, West Virginia

Midwest Region (MWRO): Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin

Mountain Plains Region (MPRO): Colorado, Iowa, Kansas, Missouri, Montana, Nebraska, North Dakota, South Dakota, Utah, Wyoming

Northeast Region (NERO): Connecticut, Maine Massachusetts, New Hampshire, New York, Rhode Island, Vermont

Southeast Region (SERO): Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee

Southwest Region (SWRO): Arkansas, Louisiana, New Mexico, Oklahoma, Texas

Western Region (WRO): Alaska, Arizona, California, Guam, Hawaii, Idaho, Nevada, Oregon, Washington

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* 4. What is the job title for your current position?

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* 5. About how long have you been in your current position?

Years

Months

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* 6. Qualifications to serve as a Regional Representative for the National CACFP Sponsors Association?

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* 7. Current and/or previous advisory positions on which you have served?

Board, Position Held, Years Served:

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* 8. Does your organization support your desire to serve in this position with the National CACFP Sponsors Association?

Yes

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* 9. Do you have any personal commitments that would prevent you from attending the NCA Annual Conference each April and serving as Regional Roundtable Moderator?

Yes

Yes, because. . .

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* 10. If appointed, will you devote the time, energy, and resources to serve in this capacity?

Yes

Explain:

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* 11. What are your personal long-range goals for the National CACFP Sponsors Association?

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* 12. What do you think Regional Sponsor Representatives could do to enhance the work of the National CACFP Sponsors Association?

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* 13. What past CACFP Sponsors Association conference(s) have you attended?

2017

2016

2015

2014

2013

2012

2011

2010

2009

2008

2007

2006

2005

2004

2003

2002

2001

None

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* 14. In what capacity did you participate in a past conference?

Attendee

Workshop Presenter

Conference Committee

Conference Chair

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* 15. On which of these NCA Committees would you be willing to serve?

Membership & Marketing

Conference

Scholarships & Excellence Awards

Policy & Regulation

Website

Corporate Development Committee

Communications

Board Development

Calendar

Nutrition Education

CACFP Week

Finance