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2017 Elections for the Board of Directors

Region 5
IL, IN, MI, MN, OH, WI

There are two directors from each region serving on the National Council Board of Directors. Ed Woods is eligible for re-election.

Per the National Council bylaws, the two directors from each region shall be affiliated with National Council voting members and should be, but are not required to be located in different states within the respective region.

If nomination is being completed by a person/organization other than the person listed below, the nominated individual must be involved in the submission process.

Nominee Information


(* Indicates required field)

*First Name:

*Last Name:

*Title/Position:

Qualifications/Credentials (MD, MSW, etc.) :

*Representing Which National Council
Member Organization:

Work Address:

*Work City:

*Work State:

Work Zip Code:

Work Phone:

Work Phone (cell):

Work Fax:

Work Email:

Home Address:

*Home City:

*Home State:

Home Zip Code:

Home Phone:

Home Phone (cell):

Home Email:


Each nominee may submit one supporting document (PDF only, no more then 5 pages). This may include a resume, letters of support, recognitions, etc. You will be able to upload your file on the next screen.
 


Each nominee may submit one photo if desired, no larger then 1 MB in size and no smaller then 150x150 pixels in size. You will be able to upload your file on the next screen.

 


I have experience in:

(Please check all that apply.)

Public Policy, Advocacy & Lobbying

Addictions Treatment

Medicare, Medicaid & Managed Care Contracting

Workforce & Leadership Development

Children & Mental Health/Addictions Treatment

Fundraising

Alliance/Coalition Building

Criminal Justice Issues

Grant Development

Fiscal Oversight

Housing & Residential Treatment Development

Inpatient Services

       

Crisis Management

Please answer the following questions:

(Text is limited to 1000 characters per question)


1. What is your professional background?

2. What in your life experience will contribute to your service on the National Council Board of Directors?

3. What experience do you have in local, statewide, and national advocacy?

4. What positions of leadership have you held (professional/civic)?

5. What special skills, talents, or services can you provide during your term of leadership?

6. What is the single most important issue/challenge you want to address during your term on the National Council Board?

7. What in your educational background will contribute to your service on the National Council Board of Directors?

8. What other information may be relevant to your nomination?

9. Personal blurb. Please provide a short bio.

Nominating Person/Organization (optional)
Check self-nominated

*First Name:

*Last Name:

*Title/Position:

*National Council Organization:

*Zip:

*Phone:

*Email:

Statement of support from person submitting nomination: (optional)

Personal/Professional References: (optional)

Each nominee may submit the names of two contacts (personal/professional) who may be contacted to serve as references.

Nominee Consent:

I have read and understand the Board Roles and Responsibilities.
 

I understand that, if elected, I am responsible for expenses incurred in serving as a member of the Board of Directors.
 

If elected, I agree to serve as a member of the Board of Directors of the National Council for Community Behavioral Healthcare.
 

I acknowledge that all information provided in this application is true to the best of my knowledge, and that the nominee has been advised of this application. I believe the National Council for Community Behavioral Healthcare will be well served to have the nominee on the Board of Directors.
 

     

Please contact Liane Kluge at lianek@thenationacouncil.org, 202-748-8793 with any questions.

 

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