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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)

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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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* 21. Are you applying for a Board position, Student Board position, or a Committee position? 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).

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

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* 24. Our Board is a working Board, which requires an investment of time and effort.
  • Board positions have a monthly meeting and usually have additional Chair meetings, which carry task responsibilities.
  • 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?

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* 25. Please indicate your primary discipline: 

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

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

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

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

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* 29. 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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* 30. 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)

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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:

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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:

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