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2023 FTA Board & Committee Application
1.
First Name
2.
Last Name
3.
Preferred Name
4.
Please list your designations, credentials, and/or licenses that you currently hold:
5.
Nominated by (current FTA member, if applicable):
6.
Note: Demographic characteristic questions are included because the principles of inclusion and development of representation of diverse populations is a focus of the FTA. For any demographic question, applicants may state they "Prefer not to say."
How do you describe your gender identity? (Check all that apply)
Female
Male
Genderqueer
Non-Binary
Agender
Transgender
Cisgender
Prefer not to say
A gender not listed above (please specify)
7.
With which racial and/or ethnic group do you identify? (Check all that apply)
American Indian or Alaska
Hispanic, Latino, or Spanish origin
White
Asian
Middle Eastern or North African
Black or African American
Native Hawaiian or Other Pacific Islander
Prefer not to say
Another race or ethnicity not listed above (please specify)her (please specify)
8.
How do you describe your sexual identity? (Check all that apply)
Heterosexual/Straight
Homosexual/Gay/Lesbian
Bisexual
Queer
Asexual
A sexuality not listed (please specify)
Prefer not to say
9.
How do you describe your disability/ability status? Note: We are interested in this identification regardless whether you typically request accommodations for this disability. (Check all that apply)
A sensory impairment (vision or hearing)
A learning disability (e.g., ADHD, dyslexia)
A long-term medical illness (e.g., epilepsy, cystic fibrosis)
A mobility impairment
A mental health disorder
A temporary impairment due to illness or injury (e.g., broken ankle, surgery)
A disability or impairment not listed above (please specify)
I do not identify with a disability or impairment
Prefer not to say
10.
What is your highest educational degree earned?
11.
Preferred Email Address
12.
Preferred Phone Number
13.
Business Name
14.
Job Title(s)
15.
Please describe your current professional position:
16.
Have you ever been convicted of a crime?
No
Yes, please explain.
17.
Have you ever had a designation, credential, license relinquished or revoked?
No
Yes, please explain.
18.
Are you, or have you ever been under notice as to any complaints by clients or any regulatory agency which have led or may lead to legal or disciplinary action?
No
Yes, please explain.
19.
Are you currently a Member of FTA?
No
Yes, How long have you been a member of FTA (in years)?
20.
Please describe your past FTA involvement and contributions.
21.
Are you applying for a Board position, Student Board position, or a Committee position? (select all that apply)
*Please note that Board members are expected to serve as a Committee Chair or Liaison.
*Application for Board positions require past committee service (except for the Student Board position).
Board position
Student Board position
Committee position
If you selected "Board position", please provide previous committee service. Otherwise select Committee or Student Board position.
22.
If you selected Board Member, and are not selected, would you be willing to serve on an FTA Committee still?
Yes
No
Not Applicable
23.
If you are applying for a Board position, FTA needs the Executive Board positions and committee chairs listed below. Please indicate which position(s) you are interested in filling: (Check all that apply)
*Please note, Board positions are for 3 years, with the exception of the Student Board Liaison, which only serves for 1 year.
*This year, the FTA Board expects the following positions to be open on the Board: President-Elect, Business Development Chair, Conference Chair for 2024, Liaison to the E&I Committee, and Student Board Member. However, please select any position that you may be interested in as additional positions may become available.
President-Elect (President in 2024) (Applicants must currently hold or have previously held an FTA Board Position)
Treasurer, Executive Board
Secretary, Executive Board
Membership Chair
Certification Chair
Business Development Chair
Social Media and Marketing Chair
Finance Chair
Conference Chair (2024)
Webinar Chair
Liaison to the Equity & Inclusion Committee
Student Board Member (Student Liaison; must be a current student for the 2023 year)
If multiple board positions are selected, please indicate the position(s) most desired.
24.
Please state the number of hours, per month, you are able/willing to commit to FTA:
25.
Our Board is a working Board, which requires an investment of time and effort.
The FTA Board meets on the third Friday of every month from 11:00 AM-12:00 Noon EST. Attendance is imperative to the successful growth of FTA.
Chair meetings are held monthly.
Committee positions generally require monthly meeting attendance and task responsibilities.
Do you have or anticipate any conflicts of interest on issues or time commitment that the Board should know about in considering your application?
No
Yes, please explain.
26.
Please indicate your primary discipline:
Mental Health
Financial
Financial Therapy
Other (please specify)
27.
Please indicate what best describes your work experience:
Scholar/Academic
Practitioner
Researcher
Other (please specify)
28.
Please outline your research and/or practice area(s) of expertise:
29.
Please rank your committee interest in the order of most preferred (1) to least preferred (8):
Most Preferred
Least Preferred
Social Media and Marketing
Most Preferred
Least Preferred
Executive Committee
Most Preferred
Least Preferred
Special Topics Webinar
Most Preferred
Least Preferred
Membership
Most Preferred
Least Preferred
Conference
Most Preferred
Least Preferred
Business Development
Most Preferred
Least Preferred
Certification
Most Preferred
Least Preferred
Equity and Inclusion Committee
Note: Members of the E&I Committee cannot serve on the FTA BOD concurrently to limit issues of influence or bias.
Most Preferred
Least Preferred
Finance Committee
Most Preferred
Least Preferred
30.
Of your list above, please indicate if you only want to be on one specific committee, or if you are ok with being placed on any of your top X number of committees (e.g., "I am happy to serve on any of my top 3 or top 5 committees"). Please list any roles or responsibilities that you would like to fulfill on your top ranked committees. Last, provide any additional commentary you would like the executive team to consider here:
31.
Please explain why you are interested in serving the FTA:
32.
Please describe strengths that you will contribute to FTA as a Board and/or committee member (e.g. leadership/self-starting, create new processes, execute existing processes, creative/marketing, strategic planning, etc.):
33.
Please share the reasoning behind any specific roles and/or responsibilities that you would prefer to fulfill next year (if applying for a Board position, for the next 3 years):
34.
What do you see as the pressing issues the Board needs to address in the next year?
35.
What future visions or directions do you have for FTA?
36.
What would be helpful to know about you that is not already listed or described in the application (e.g. please describe what makes you different from other applicants)?
37.
Attach Resume or CV
Choose File
No file chosen
38.
If selected, I agree to abide by the FTA Bylaws in my role as a Board or Committee Member.
Please type your name below to indicate your agreement with this:
No
Yes, and Sign Name:
Current Progress,
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