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PA Foundation Board of Trustees
2024 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, 2024, and ending June 30, 2027.
Please review the
2024 Nominee Information Guide
before completing the application below.
Please confirm you have read and acknowledge the requirements of trustee service as outlined in the 2024 Nominee Information Guide.
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Yes, I have read and acknowledge the requirements.
Nominee Information
First Name
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Middle Initial:
Last Name
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Home Address
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Address Line 2
City
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State
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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
Zip Code
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Phone Number
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Email Address
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Employer Name:
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Your Title:
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Employer Address
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Address Line 2
City
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State
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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
Zip Code
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Work Phone Number
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Work Email Address
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Preferred method of contact:
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Home
Work
Background/Qualifications
Are you a PA?
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Yes
No
Please list your profession:
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Practice setting:
Specialty:
Number of years in practice:
Number of years in this profession:
AAPA Member ID, if applicable
(note: PA nominees must be AAPA Fellow member in good standing)
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Please select the areas in which you have experience and relationships
(check all that apply)
:
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Health equity and DEI programmatic funding
Corporate foundations (e.g. pharma, insurers, biotechnology, other healthcare industry partners)
Private foundations
State or regional funders
Other
Other
Please describe your background/experience and relationships in the areas selected above.
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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.
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2. Please explain what motivates you to apply for a volunteer position with the PA Foundation Board of Trustees.
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3. Please briefly outline the specific skills you bring, or contributions you hope to make, to the PA Foundation Board.
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4. The PA Foundation's mission is
to empower PAs to improve health through philanthropy and service
. Briefly explain what this mission means to you.
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File Uploads
Résumé/curriculum vitae:
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Thank you for your interest in serving your Foundation!