Public Health Community DPG Election Interest Form

Public Health DPG Election Interest Form
Thank you for your interest in getting more involved with the PHCN DPG.

Please indicate below which volunteer position you are interested in. Open positions are filled throughout the year. Elected leadership position nominations (Chair-elect, treasurer, etc.) will be accepted through Friday, December 1, 2023.
Name

First NameLast Name
Credentials
Email
example@example.com
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home or Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Employment Position
Which volunteer roles are you interested in? (select all that apply)
Please select the PHCN position for which you would like to be nominated.
Do You Currently Hold or Are You Running for Another Elected Position?
Volunteers are required to attend, at minimum, their committee meeting and the PHCN DPG Executive Committee meeting each month, for approximately 2 hours. Can you commit to participating regularly to these meetings or submitting written reports in your absence?
Personal Statement: Tell us why you are interested in running for this position in 100 words or less

0/100
Please List Technology or Other Skills Related to the Position:
Please List Academy-PHCN DPG and Public Health Nutrition Related Organizational Activities (begin with most recent):
Please List Leadership Positions Held (begin with most recent):
Please Upload Current CV/Resume

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Please Upload Professional Headshot

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Should be Empty:

Public Health DPG Election Interest Form