PA Foundation Board of Trustees
2019 Call for Nominations

The PA Foundation Committee on Nominations is seeking individuals to serve as members of the Board of Trustees. The incoming Board members selected through this nominations cycle will serve a term beginning July 1, 2019, and ending June 30, 2022.

Please review the 2019 Nominee Information Guide before completing the application below.

Nominee Information

First Name *

Middle Initial:

Last Name *

Home Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Employer Name: *

Your Title: *

Employer Address *

Address Line 2

City *

State *

Zip Code *

Preferred method of contact: *

Home

Work

Background/Qualifications

Practice setting: *

Specialty: *

Number of years in practice: *

AAPA Member ID (note: nominee must be AAPA Fellow member in good standing): *

Please list non-profit boards and committees that you serve on or have served on (business, civic, community, fraternal, political, professional, recreational, religious, social).

	Organization Name	Role/Title	Dates of Service
1.	Organization Name	Role/Title	Dates of Service
2.	Organization Name	Role/Title	Dates of Service
3.	Organization Name	Role/Title	Dates of Service
4.	Organization Name	Role/Title	Dates of Service

Free Responses

1. Please briefly describe your professional background and other relevant experience. *

2. Please explain what motivates you to apply for a volunteer position with the PA Foundation Board of Trustees. *

3. Please briefly outline the specific skills you bring, or contributions you hope to make, to the PA Foundation Board. *

4. The PA Foundation's mission is to empower PAs to improve health through philanthropy and service. Briefly explain how this mission inspires you. *

5. The Nominations Committee seeks expertise in either mental health OR non-clinical corporate healthcare settings. Please describe your background or expertise in at least one of these areas. *

File Uploads

Résumé/curriculum vitae: *

Headshot:

Thank you for your interest in serving your Foundation at this high level.