PSA Committee Application 2024 Term

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* 1. Contact information

Name

Company

Job Title

Email Address

Phone Number

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* 2. Requested committee (List top 5 choices in order of preference)

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* 3. Please check the box if you are interested in a Chair position. Please ensure that you have read and understand the requirements associated with the Chair role

Chair

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* 4. Relevant educational background/certifications/work experience:

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* 5. Statement of your job responsibilities relating to committee(s) named:

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* 6. Special contributions you can make or strengths you can bring to the work of the named committee(s):

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* 7. Why do you want to serve on this/these committee(s)?

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* 8. Do you have the support and approval of your organization's management to meet the commitments and requirements of a PSA committee?

Yes

Other (please specify)

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* 9. Supervisor Contact Information

Supervisor Name

Supervisor Title

Supervisor Email Address

Supervisor Phone Number

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* 10. Have you read the Committee charter as outlined by PSA?

Yes, I have reviewed the Committee charter

No, please send a copy of the Committee charter to review

PSA Committee Application 2024 Term

Question Title

* 1. Contact information

Question Title

* 2. Requested committee (List top 5 choices in order of preference)

Question Title

* 3. Please check the box if you are interested in a Chair position. **Please ensure that you have read and understand the requirements associated with the Chair role**

Question Title

* 4. Relevant educational background/certifications/work experience:

Question Title

* 5. Statement of your job responsibilities relating to committee(s) named:

Question Title

* 6. Special contributions you can make or strengths you can bring to the work of the named committee(s):

Question Title

* 7. Why do you want to serve on this/these committee(s)?

Question Title

* 8. Do you have the support and approval of your organization's management to meet the commitments and requirements of a PSA committee?

Question Title

* 9. Supervisor Contact Information

Question Title

* 10. Have you read the Committee charter as outlined by PSA?

* 3. Please check the box if you are interested in a Chair position. Please ensure that you have read and understand the requirements associated with the Chair role