ACA Individual & Family Advisory Board Application

Applicant's Information

Thank you for your interest in ACA's Individual & Family Advisory Board. Please complete the below questions so we can get to know you better.

Question Title

* 1. Please provide your contact information.

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. What is your preferred language of communication?

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* 3. What is your preferred method of contact?

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* 4. Is there someone else we should contact who helps you communicate or schedule appointments?

Yes (Please provide name, relationship and contact information in the box below.)

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* 5. What role do you play within the ACA family?

Individual

Family

Advocate

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* 6. Why do you want to join ACA's Advisory Board?

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* 7. Do you have past/current experience participating in other Committees or Advisory Boards?

If yes, please specify.

ACA Individual & Family Advisory Board Application

Applicant's Information

Question Title

* 1. Please provide your contact information.

Question Title

* 2. What is your preferred language of communication?

Question Title

* 3. What is your preferred method of contact?

Question Title

* 4. Is there someone else we should contact who helps you communicate or schedule appointments?

Question Title

* 5. What role do you play within the ACA family?

Question Title

* 6. Why do you want to join ACA's Advisory Board?

Question Title

* 7. Do you have past/current experience participating in other Committees or Advisory Boards?

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* 8. Are you willing and able to travel for meetings?

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* 9. Are you willing and able to commit to quarterly in person meetings?

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* 10. Would you be interested in holding an officer position on the Board?

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* 11. Please tell us a bit about some topics you would like to discuss and/or information you would like provided.