NCIL 2011 Board of Directors Nomination Form

Please check with your Nominee regarding his or her willingness to run prior to making a nomination and provide them with a copy of the position description and memo from the NCIL Board regarding obligations of NCIL Board members.

* Required

Position Being Nominated For: *

Nominee

Name *

Region: *

Center or SILC: *

Phone: *

TTY (optional):

Email: *

Nominator

Name *

Address *

City: *

State: *

Zip Code: *

Phone: *

TTY (optional):

Email: *

Membership Type: *

As the nominator of this prospective board member, please work with the nominee to complete the following information:

What is the length of time s/he has been an individual member of NCIL? *

Has s/he served on any NCIL committees, subcommittees or task forces? If so, which one(s)? *

What does s/he consider her/his greatest accomplishment as an advocate during his/her involvement in Independent Living? *

What skills, talents and resources will s/he bring to the NCIL board? *

Why does this person want to serve on the NCIL Board? *

Your electronic signature affirms that you contacted the nominee and that he or she has agreed to run: *