NDEP Nomination Application Form
This form is designed to collect nominee information. Please complete this form in its entirety and email it no later than November 2 for review by the NDEP Nominating Committee. To review position descriptions of NDEP Council positions, visit the NDEP website. You must be a current NDEP member to be considered for these positions; however, you do not need to be in a current leadership position within NDEP. NDEP provides equal opportunities to all applicants for volunteer work and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
Position sought on NDEP Council
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Vice Chair (6.1.2027 through 5.31.28, then Chair from 6.1.28 through 5.31.29, then Past Chair from 6.1.29 through 5.31.30)
House of Delegates-NDEP Delegate (6.1.27 though 5.31.30)
Preceptor Director (6.1.27 through 5.31.29)
Regional Director-West Coast (6.1.27 through 5.31.29)
Regional Director-North Central (6.1.27 through 5.31.29)
Regional Director-North East (6.1.27 through 5.31.29)
Name
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First Name
Last Name
Credentials
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Academy Member Number
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Phone Number
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Email
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example@example.com
Educational and Professional Background
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Educational path toward current degrees and credentials (150 word limit)
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Institution(s) completed to obtain Master's and/or Doctoral degrees, if applicable
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Current Professional position and responsibilities (150 word limit)
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Current Professional memberships and contributions (150 word limit)
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Highlight your NDEP and/or dietetics-related professional activity, including leadership in dietetics-related roles, of past 5-10 years. (150 word limit)
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Nominee Rationale
Provide a statement of interest and potential involvement in NDEP. (150 word limit)
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Provide your personal narrative of experience as an educator or preceptor that qualifies you to serve in the potential NDEP position. (150 word limit)
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What opportunities do you see for NDEP and how can you help promote these opportunities? (150 word limit)
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Is there any information you would like the nominating committee to consider?
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Signature
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Date
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Day
Year
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Date
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