2023 FTA Board & Committee Application

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* 1. First Name

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* 2. Last Name

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* 3. Preferred Name

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* 4. Please list your designations, credentials, and/or licenses that you currently hold:

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* 5. Nominated by (current FTA member, if applicable):

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* 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)

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* 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)

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* 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

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* 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

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* 10. What is your highest educational degree earned?

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* 11. Preferred Email Address

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* 12. Preferred Phone Number

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* 13. Business Name

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* 14. Job Title(s)

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* 15. Please describe your current professional position:

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* 16. Have you ever been convicted of a crime?

Yes, please explain.

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* 17. Have you ever had a designation, credential, license relinquished or revoked?

Yes, please explain.

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* 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?

Yes, please explain.

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* 19. Are you currently a Member of FTA?

Yes, How long have you been a member of FTA (in years)?

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* 20. Please describe your past FTA involvement and contributions.

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* 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.

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* 22. If you selected Board Member, and are not selected, would you be willing to serve on an FTA Committee still?

Yes

Not Applicable

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* 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.

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* 24. Please state the number of hours, per month, you are able/willing to commit to FTA:

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* 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?

Yes, please explain.

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* 26. Please indicate your primary discipline:

Mental Health

Financial

Financial Therapy

Other (please specify)

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* 27. Please indicate what best describes your work experience:

Scholar/Academic

Practitioner

Researcher

Other (please specify)

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* 28. Please outline your research and/or practice area(s) of expertise:

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* 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	Social Media and Marketing Most Preferred	Social Media and Marketing	Social Media and Marketing	Social Media and Marketing	Social Media and Marketing	Social Media and Marketing	Social Media and Marketing	Social Media and Marketing Least Preferred
Executive Committee	Executive Committee Most Preferred	Executive Committee	Executive Committee	Executive Committee	Executive Committee	Executive Committee	Executive Committee	Executive Committee Least Preferred
Special Topics Webinar	Special Topics Webinar Most Preferred	Special Topics Webinar	Special Topics Webinar	Special Topics Webinar	Special Topics Webinar	Special Topics Webinar	Special Topics Webinar	Special Topics Webinar Least Preferred
Membership	Membership Most Preferred	Membership	Membership	Membership	Membership	Membership	Membership	Membership Least Preferred
Conference	Conference Most Preferred	Conference	Conference	Conference	Conference	Conference	Conference	Conference Least Preferred
Business Development	Business Development Most Preferred	Business Development	Business Development	Business Development	Business Development	Business Development	Business Development	Business Development Least Preferred
Certification	Certification Most Preferred	Certification	Certification	Certification	Certification	Certification	Certification	Certification 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.	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	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.	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.	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.	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.	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.	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.	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. Least Preferred
Finance Committee	Finance Committee Most Preferred	Finance Committee	Finance Committee	Finance Committee	Finance Committee	Finance Committee	Finance Committee	Finance Committee Least Preferred

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* 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:

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* 31. Please explain why you are interested in serving the FTA:

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* 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.):

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* 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):

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* 34. What do you see as the pressing issues the Board needs to address in the next year?

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* 35. What future visions or directions do you have for FTA?

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* 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)?

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* 37. Attach Resume or CV

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 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:

Yes, and Sign Name:

2023 FTA Board & Committee Application

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Preferred Name

Question Title

* 4. Please list your designations, credentials, and/or licenses that you currently hold:

Question Title

* 5. Nominated by (current FTA member, if applicable):

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* 7. With which racial and/or ethnic group do you identify? (Check all that apply)

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* 8. How do you describe your sexual identity? (Check all that apply)

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* 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)

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* 10. What is your highest educational degree earned?

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* 11. Preferred Email Address

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* 12. Preferred Phone Number

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* 13. Business Name

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* 14. Job Title(s)

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* 15. Please describe your current professional position:

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* 16. Have you ever been convicted of a crime?

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* 17. Have you ever had a designation, credential, license relinquished or revoked?

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* 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?

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* 19. Are you currently a Member of FTA?

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* 20. Please describe your past FTA involvement and contributions.

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* 22. If you selected Board Member, and are not selected, would you be willing to serve on an FTA Committee still?

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* 24. Please state the number of hours, per month, you are able/willing to commit to FTA:

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* 26. Please indicate your primary discipline:

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* 27. Please indicate what best describes your work experience:

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* 28. Please outline your research and/or practice area(s) of expertise:

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* 29. Please rank your committee interest in the order of most preferred (1) to least preferred (8):

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* 31. Please explain why you are interested in serving the FTA:

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* 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.):

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* 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):

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* 34. What do you see as the pressing issues the Board needs to address in the next year?

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* 35. What future visions or directions do you have for FTA?

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* 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)?

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* 37. Attach Resume or CV

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* 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:

* 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: