Governance Candidacy Form

Please give your name or that of the person you're nominating.
If different from above.
Please list participation in any boards, committees, or groups relevant to the elected position the nominee is seeking.
Include honors, publications, presentations, leadership roles, etc.
E.g., grant-writing experience, marketing, strategic planning, research, fundraising, etc.
Please describe why you believe this individual would be a fitting candidate for this position.
Tell us which awards committee the nominee is planning to run for
Please review the Board Conflict of Interest Disclosure Statement at