(for the term beginning Jan. 1, 2027 and ending Dec. 31, 2027)

NOTE: If an individual is being nominated for more than one position, a separate nomination form should be completed for each position.

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* 1. Submitted By:

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* 2. From the State of:

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* 3. Recommended Committee, Task Force or Board

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* 4. Recommended Individual's Name

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* 5. Designations, if known

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* 6. Recommended Individual's Agency Name

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* 7. Recommended Individual Agency's Address

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* 8. Recommended Individual's Agency Phone Number

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* 9. Recommended Individual's Email Address

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* 10. Please describe previous experience and other qualifications that suit this association member/employee for the committee/task force/board for which he/she is being nominated.

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* 11. Please describe previous participation of the nominated association member/employee on IIABA and state association committees/task forces/boards.

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* 12. For a nomination who is or has been an IIABA Director and/or officer of the state association, please list his/her dates of service and roles.

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* 13. If available, a resume or biography should be attached.  Please note that the purpose of the resume or biography is to provide additional information about the individual, and not to take the place of answering any of the questions above.

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