AAPCA1 Board 2021-22 Nomination Application Survey

1.Please provide the following contact information:

Name (first, last)

Institution/Practice

Title

Email Address

AAP ID# *

*You must be a member of the chapter to serve on the board. If you are not a member, you may join the chapter here: https://aapca1.org/membership/

2.I am applying for:

MAL for Region 2 (El Dorado, Nevada, Placer, Sacramento, Yolo counties)

MAL for Region 3 (Alpine, Amador, Calaveras, San Joaquin, Stanislaus and Tuolumne counties)

MAL for Region 5 (San Francisco, includes Daly City)

MAL for Region 11 (Contra Costa and Solano counties)

AAP California Chapter 1 Vice President

3.Please list current/past roles in the AAP (local, district or national).

4.Please describe current/past leadership activities.

5.Please describe experiences that you have with fostering diversity, equity and inclusion in a professional setting.

6.Please describe your interest in becoming a MAL including any specific contributions you would like to make to the Chapter and any specific topical interests (300 word limit).

7.Narrative biosketch: Please provide a brief biography that could be included with the election ballot (250 word limit).

Photograph: Please email a photograph that we can include with the election ballot to info@aapca1.org.

If you have any questions about the position or application, please do not hesitate to contact us at info@aapca1.org.

Current Progress,

0 of 7 answered