2014 Committee on Nominations Application for term beginning in 2015

2015 Committee on Nominations Application Personal Information - Due April 30, 2014

Thank you for your interest in serving as a member of the AHVRP Nominations Committee! We very much appreciate your willingness to serve.

THIS INFORMATION WILL BE USED FOR THE ACTUAL BALLOT IF YOU ARE SLATED. SPACE IS LIMITED SO BE SURE TO INCLUDE YOUR MOST PERTINENT INFORMATION.

Question Title

* 1. Please review the Nominations Committee member requirements and expectations in the AHVRP Call for Leaders packet, before moving forward with this form. Term begins January 1, 2015.

Yes, I have read the expectations and I am able to fufill the obligations of this position.

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* 2. Enter your personal information.

First Name:

Last Name:

Title:

Institution:

Address:

City, State, Zip:

Work Phone:

Fax:

Home Phone:

Email Address:

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* 3. Enter your supervisor's contact information. Please note that your supervisor will be contacted as an additional professional reference.

First Name:

Last Name:

Title:

Email Address:

Address:

City, State, Zip:

Work Phone:

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* 4. May the Committee on Nominations consider you for another AHVRP position, including Board at Large or a committee chair?

Yes

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* 5. Your professional affiliations including state, regional, and local office/committees (within the last five years):

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* 6. Association for Healthcare Volunteer Resource Professionals (AHVRP):

Year joined AHVRP (yyyy):

Number of annual conference(s) attended:

If CAVS Certified, please note number of years certified.

2014 Committee on Nominations Application for term beginning in 2015

2015 Committee on Nominations Application Personal Information - Due April 30, 2014

Question Title

* 1. Please review the Nominations Committee member requirements and expectations in the AHVRP Call for Leaders packet, before moving forward with this form. Term begins January 1, 2015.

Question Title

* 2. Enter your personal information.

Question Title

* 3. Enter your supervisor's contact information. Please note that your supervisor will be contacted as an additional professional reference.

Question Title

* 4. May the Committee on Nominations consider you for another AHVRP position, including Board at Large or a committee chair?

Question Title

* 5. Your professional affiliations including state, regional, and local office/committees (within the last five years):

Question Title

* 6. Association for Healthcare Volunteer Resource Professionals (AHVRP):

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* 7. List AHVRP offices/committees served (within the last five years):

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* 8. Why are you the best qualified candidate for this position? This personal statement will appear on ballot. (250 words or less)