Nominee Information Form

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* 1. Name and Credentials:

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* 2. Position nominating for:

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* 3. Email:

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* 4. Phone:

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* 5. How many years have you been an ASCP Member?

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* 6. Current/Past Employment:

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* 7. Education/Awards:

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* 8. ASCP Involvement: (Please list all committees, leadership groups, chapter involvement, task forces, etc.)

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* 9. Involvement in Other Organizations: (Please list other Boards and/or leadership groups you serve on, and the related organizations/associations)

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* 10. Please list the ASCP meetings (national and regional) you have attended in the past 5 years:

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* 11. What strengths do you feel you will bring to the ASCP Board?

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* 12. What will you bring to the table to help ASCP retain current members and attract new members?

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* 13. For Board candidates only: What are your individual goals for ASCP and the region that you will represent?

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* 14. For president-elect candidates only: What are your highest priorities for ASCP?

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* 15. In addition to this completed Nominee Information Form, I agree to send the following materials to dfurman@ascp.com by January 29:
1.    Brief biographical sketch (600 word limit)
2.    Curriculum vitae or resume
3.    Letter of Recommendation (preferably from an ASCP member)
4.    Professional quality, recent headshot (color) in either .JPG or .TIF format, 300 dpi. (optional)

All candidates will be sent to read and review ASCP’s governing and policy documents associated with service as an elected official of ASCP.

If elected to office, individuals are expected to comply with all the governing and policy documents. In addition, they will be required to sign and submit a disclosure statement and a nondisclosure agreement.

Nomination Packages must be submitted to Debbie Furman at dfurman@ascp.com by January 29, 2016. If you have additional questions about the ASCP Board and/or the nominations process, please contact Debbie Furman at dfurman@ascp.com or 703-739-1300 x146.

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