CPA Board of Directors Application

CPA is committed to establishing a Board of Directors that is reflective of the diverse communities we serve throughout the state of Pennsylvania. As an equal opportunity organization with a commitment to Diversity, Equity, Inclusion, and Belonging (DEIB), we will proudly consider all qualified applicants.

Question Title

* 1. Please enter your contact information.

Name *

Organization/Coalition *

Address *

Address 2

City/Town *

State *

ZIP/Postal Code *

County *

Email Address *

Phone Number *

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* 2. How long have you worked in the field of Prevention?

Less than 1 year

1-2 years

2-5 years

6-10 years

11-15 years

16-20 years

20+ years

I do not work in the prevention field

Question Title

* 3. What CPA Region is your county in?
(Please see the regional map below)

Region 1

Region 2

Region 3

Region 4

Question Title

Region Map

<span style="text-decoration: underline;"><span style="color: #0000ff;"><a href="https://commonwealthpreventionalliance.org/about/regional-news/" rel="nofollow" style="color: #0000ff; text-decoration: underline;" target="_blank">Region Map</a></span></span>

CPA Board of Directors Application

Question Title

* 1. Please enter your contact information.

Question Title

* 2. How long have you worked in the field of Prevention?

Question Title

* 3. What CPA Region is your county in?(Please see the regional map below)

Question Title

Region Map

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* 4. Are you currently serving on the CPA Board of Directors?

* 3. What CPA Region is your county in?
(Please see the regional map below)