Form N: Nominating Work Group Candidate Application

FORM N: AAPA NOMINATING WORK GROUP CANDIDATE APPLICATION

* First Name:

* Last Name:

* Street Address:

* City:

* State:

* Zip Code:

* Phone Number:

* E-mail:

* AAPA ID #:

* Years as AAPA Fellow Member (minimum of 5):

Professional Experience:

The following shall be qualifications for candidates for election to the AAPA Nominating Work Group:
a.     A candidate must be a fellow member of AAPA.
b.     A candidate must have been an AAPA fellow member for at least 5 years.
c.     A candidate must have accumulated at least five years of experience in the past seven years
        in at least two of the following major areas of professional involvement.
       1) an AAPA or constituent organization office, board member or committee chair
       2) a delegate or alternate of the AAPA House of Delegates
       3) PA Foundation, Society for the Preservation of Physician Assistant History, or American
            Academy of Physician Assistants Political Action Committee trustee or committee chair
       4) AAPA board appointees
d. Any calendar year or Academy year in which the candidate served in more than one area of
     professional involvement shall be counted as one distinct year of experience.
e. With the exception of the board-appointed members, a Nominating Work Group member cannot
     hold any other elected office or standing committee position in the AAPA during the time of
     service to the Nominating Work Group.
f.   Nominating Committee candidates should pre-declare. Write-in candidates will be accepted at
     the time of elections.
g. The Governance Commission chairperson will confirm verified qualifications to the second vice
     speaker of the House.

* List your five years of experience that meet the Nominating Work Group criteria listed above. List any present or previous leadership experience including but not limited to organizations that you have served as a committee, council, or board member. Please include the organization name and dates of office.

* Have you ever been a delegate to the AAPA House of Delegates?

No

Yes (years served)

* Please develop a platform statement explaining why you wish to serve on the Nominating Work Group. Tell us why you are running and what you hope to bring to the work group if you are elected.

Are there any additional volunteer experiences that will make you a valuable committee member, such as serving on a community/hospital board or committee, church leadership, youth group leader, etc.?

Please attach your CV/Resume as either a word document or a PDF file. If your browser does not have this capability, please e-mail it to tshoemaker@aapa.org.

* I am an AAPA Fellow Member. I understand that, if selected for service, I will be required to attend work group meetings for the Nominating Work Group.

Yes

No

* Date:

Candidates must submit their applications by March 30 in order to have their materials included in the HOD meeting materials download. If you miss the deadline, you may declare your candidacy on the floor of the HOD and provide your own written materials for dissemination at the House.

* Indicates Response Required