National Scleroderma Foundation Patient Advisory Board Survey

Call for Leadership Nominations

Join the National Scleroderma Foundation in leading the Foundation into the future.

The charge of the Patient Advisory Board (PAB) is to advise the Board of Directors on matters requiring patient perspective and input, including recommendations with respect to the effective application of the Foundation’s mission.

Pending approval, new PAB members will begin service July 1, 2023 and serve a three-year term to end June 30, 2026.

*** Applications are due online by 5:00 pm ET on Friday, April 7, 2023 ***

1.Name: (Required.)

2.Email: (Required.)

3.Best phone number to reach you: (Required.)

4.Chapter Affiliation, if any: (Required.)

5.Describe any prior service to the Foundation (e.g., support group leader, chapter leadership, committee or working group, etc.):(Required.)

6.How long have you been living with scleroderma?(Required.)

7.How do you connect with the mission of the Foundation?(Required.)

8.Why do you want to serve on the PAB?(Required.)

Demographic information

To ensure we are recruiting and developing a diverse board, we collect demographic information. This is optional, but it will help us ensure we meet our diversity, equity and inclusion goals in terms of representation and voice.

9.Date of Birth: (Required.)

10.Gender identity: (Required.)

11.Preferred pronouns: (Required.)

12.What is your nationality?

13.Ethnicity: (Required.)

14.What languages do you speak?(Required.)

15.Where do you live? (Required.)

Current Progress,

0 of 15 answered