2020-2021 ACA Call for Volunteers Nomination Form Thank you for your interest in volunteering or nominating someone to for a volunteer opportunity at ACA. Please fill out the information below to be considered for appointment. Incomplete applications will not be considered. Name & Demographics Question Title * 1. Personal Information First and Last Name City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming Country Email Address Phone Number Question Title * 2. ACA Member ID (you must be an active ACA member to apply) Question Title * 3. Membership Class Professional New Professional Regular Student Retired Question Title * 4. Membership Expiration Date Date / Time Date Education & Licensure Question Title * 5. What is your highest degree obtained or presently working toward? Question Title * 6. Major Course of Study: Question Title * 7. Institute of Higher Education: Question Title * 8. Graduation Date (if a student please list projected graduation date) Date / Time Date Question Title * 9. Are you licensed as a professional counselor? Yes No If yes, what license do you hold? Nomination Question Title * 10. Source of Nomination Self-Nomination Nominated Nominated by: Question Title * 11. ACA volunteer opportunity for which this person is applying/nominated (Please rank the Volunteer opportunities in the order of your interests, One being most interested. ) : 1 2 3 4 5 6 7 8 9 10 11 12 13 Awards Committee 1 2 3 4 5 6 7 8 9 10 11 12 13 Branch Development Committee 1 2 3 4 5 6 7 8 9 10 11 12 13 Bylaws Committee 1 2 3 4 5 6 7 8 9 10 11 12 13 Ethics Committee 1 2 3 4 5 6 7 8 9 10 11 12 13 Graduate Student Committee 1 2 3 4 5 6 7 8 9 10 11 12 13 Human Rights Committee 1 2 3 4 5 6 7 8 9 10 11 12 13 International Committee 1 2 3 4 5 6 7 8 9 10 11 12 13 Professional Standards Committee 1 2 3 4 5 6 7 8 9 10 11 12 13 Public Policy & Legislation Committee 1 2 3 4 5 6 7 8 9 10 11 12 13 Publications Committee 1 2 3 4 5 6 7 8 9 10 11 12 13 Research & Knowledge Committee 1 2 3 4 5 6 7 8 9 10 11 12 13 ACA Task Forces - appointments typically last one year or less 1 2 3 4 5 6 7 8 9 10 11 12 13 Micro Volunteering Opportunities - these are opportunities which provide a chance to contribute your expertise in short term projects Question Title * 12. For Committee Positions (please select one) Professional Member (3-year term) Student Member (1-year term) Student members serving on the Graduate Student Committee serve 3-year terms. Question Title * 13. If you are nominating for an ACA Standing Committee - Statement of Interest (Describe why you are nominating yourself or another member to this committee). Question Title * 14. Skills/Qualifications (Describe any special skills that especially qualify individual for this committee.) Question Title * 15. Experience (List up to five leadership roles or volunteer activities that speak to individual's qualifications and/or prior service to ACA.) Statement of Commitment Question Title * 16. ACA Committee/Task Force Statement of Commitment I have read and understand the ACA Committee/Task Force Statement of Commitment. Please do no submit CVs or recommendation letters as part of your application. Additional attachments are not accepted. Submit