AAPA COMMISSION AND WORK GROUP SERVICE APPLICATION
For more information about the new governance structure
click here
. Please be aware that there are very few openings this year.
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I am interested in AAPA leadership opportunities and am applying for the following position:
Work Group - application due March 15
Commission - application due March 15
All applicants: please state the commission or work group for which you are applying. (If you are interesting in applying for the Nominating Work Group,
please fill out Form N
).
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I am applying for this service:
Clinical and Health Affairs Commission
Quality Care Work Group (of the Clinical and Health Affairs Commission)
Health Disparities Work Group (of the Clinical and Health Affairs Commission)
Professional Practice Commission
Research Advisory Work Group (of the Professional Practice Commission)
Membership Commission
Awards Work Group (of the Membership Commission)
Judicial Affairs Work Group (of the Membership Commission)
Advocacy and Government Affairs Commission
State Legislative Affairs Work Group (of the Advocacy and Government Affairs Commission)
Federal Affairs Work Group (of the Advocacy and Government Affairs Commission)
Reimbursement Issues (of the Advocacy and Government Affairs Commission)
Regulatory Affairs Work Group (of the Advocacy and Government Affairs Commission)
Professional Education Commission
Conference Education and Planning Work Group (of the Professional Education Commission)
Leadership Development Work Group (of the Professional Education Commission)
Governance Commission
Nominating Work Group (of the Governance Commission)
Constituent Relations Work Group (of the Governance Commission)
Task Force (to be announced as needed)
I am applying to be the chair:
Yes
No
Background Information:
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First Name:
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Last Name:
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Street Address:
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City:
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State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
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Zip Code:
Phone Number:
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E-mail:
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AAPA ID #:
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Years as Fellow Member:
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Years as Student Member:
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Constituent Organization Affiliation Name:
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Years of Membership:
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Previous Constituent Organization Affiliation Name:
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Years of Membership:
Professional Experience:
Please write a cover letter explaining why you wish to serve in the commission or work group role you selected. Please indicate any past experience you feel is pertinent to the position.
Please list any present or previous leadership experience, including but not limited to any organization that you have served as a committee, council, or board member. Please include the organization name and dates of service.
Are there any additional volunteer experiences that will make you a valuable AAPA volunteer, such as community service, fundraising, coaching, etc?
Please attach your CV/Resume as either a word document or a PDF file. If you browser does not have this capability, please e-mail it to
marilyn@aapa.org
.
Please attach an electronic photo. If your browser does not have this capability, please e-mail it to
marilyn@aapa.org
.
Send additional materials to:
AAPA
Commission/Work Group Service Application
950 North Washington Street
Alexandria, VA 22314
Fax materials to 703-684-1924
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I am an AAPA Fellow Member:
Yes
No
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Today's Date:
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Indicates Response Required