2026 AMHCA Special Election Board Application Survey

4.Basics

This application will take about 20 minutes to complete. To expedite the application process it is recommended that you have the following available for entering and uploading:

State license type and number
Know if you are a current member of AMHCA and a member for the past three consecutive years
Resume or CV
Have three (3) references with email addresses
Candidate statement for the website
Photo (to go with the candidate statement on our website)
Recommendation letter from State Chapter (if there is an AMHCA chapter in your state)
3-5 Minute video about why you want to serve on the AMHCA Board of Directors

Applications Due by April 17, 2026

100%

1.Name and Credentials

2.State License Type and License Number

3.Are you an AMHCA member?

Yes

4.Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

5.Best Day(s) Time(s) to Call

6.Has your license (in any State) ever been suspended or revoked?

Yes

7.If yes to the above question, please explain.

8.Have you ever resigned or been asked to resign from another association board or organization?

Yes

9.If yes to the above question, please explain