2017-2018 Executive Board and Regional Director Nominee Application Form As a nominee for an Executive Board or Regional Director position, please review the CIVSA Bylaws, Nominating Policy & Procedures and the CIVSA Operations Manual for all details pertaining to nominations, elections and position job descriptions. The CIVSA Nominee Packet with all requested documents must be fully completed and sent to nominations@civsa.org by no later than January 13, 2017.

Name: Title:

Institution: Region:

Address: City: State: Zip:

Office Phone: Office Fax:

Email: _ Home Phone:

The following positions will be elected for 2017 - 18. Please indicate the position(s) you seek:

President-Elect: three-year term – President-Elect, President and Immediate Past President Secretary: one-year term Treasurer: two-year term Regional Director: one-year term

The goal of the Nominating Committee is to present a slate of the most qualified nominees to the membership for election. The Nominating Committee may select a slate that includes one, two or multiple nominees per position. Please indicate your willingness to be slated as a nominee in each of the following options (the Committee Chair will notify each nominee of the slate prior to completing the slate):

Single, Dual or Multiple Slate: I am willing to run for office on a single, dual or multiple slates.

Single Slate Only: I am willing to run for the above position ONLY if the Nominating Committee slates me as the nominee for that position.

My signature below indicates that:

• I have read the CIVSA Bylaws, Operations Manual, Nominating Policy & Procedures and the job description for the aboveposition and am prepared to assume the responsibilities required of this position.

• I have received the full support of my institution and supervisor as indicated in this packet.• The information I have provided about my background and experience is accurate to the best of my knowledge.• I understand the Nominating Committee may contact nominees or references for additional information.

Signature: Date:

Please provide the following information, attaching separate pages as necessary.

1. Explain how your professional background, training, experience and/or personal qualities support your nomination for the position you seek? (Please provide no more than 500 words)

2. Provide a resume in any format of your choosing which can include the following information or any other information you deem pertinent to your nomination:

a. Professional experiences including present job responsibilities, supervisory roles, previous job listings and dates of employment.b. Educational background including institutions and degrees earned.c. CIVSA involvement including time of membership, conferences attended committee service or other positions held.d. Professional memberships, community/campus leadership, awards and honors

3. Have two members complete the Nominee Reference Form (for Executive Board positions one must be from any member in Good standing and the second from a current member of the Executive Board, for Regional Director Positions both can be from any member in good standing)

4. Provide the Nominee Statement of Institutional Support (to be completed by your immediate supervisor)

All documents of the CIVSA Nominee Packet must be e-mailed to nominations@civsa.org by January 13, 2017.

2017 - 2018 Executive Boar d and Regional Director Nominee Reference Form

Nominee: Please fill in your name and institution only and give copies of this form to your two references. For Executive Board members one reference must be from a current Executive Board member and one must be from any member in good standing. For Regional Directors, both references should come from members in good standing.

Nominee Name: Nominee Institution: _

Reference Name: Reference Institution:

Reference Phone: Reference Email:

Context in which you know the nominee:

How long have you known the nominee?

Please list any CIVSA leadership positions in which you are currently serving:

Reference: Please provide information on the nominee’s qualities, experience, skills and knowledge that support his/her nomination for this CIVSA leadership role. Please keep the letter of reference to less than 500 words. In making your reference of the nominee, we ask that you look at the CIVSA Operations Manual to view the position job description for which the nominee is seeking.

The information you provide will be shared with the Nominating Committee and will otherwise be kept confidential. Please note that the Committee may choose to contact you for additional information or questions. Contact the Nominating Committee Chair, Jaime Rensel via e-mail at jaime.rensel@asu.edu if you have any questions. Please attach separate pages as necessary.

Please notify the Nominating Committee of your confidentiality preference:

This reference can be shared with the nominee upon request from the nominee.

I prefer this reference to remain confidential and not be shared with the nominee.

This reference form must be e-mailed to nominations@civsa.org by January 13, 2017.

2017 – 18 Executi ve Board and Regional Director Nominee Statement of Institutional Support

Nominee: Please complete the top portion of the Nominee Statement of Institutional Support, and then ask your employer to complete the rest of the form and return it by e-mail to nominations@civsa.org by January 13, 2017.

Nominee’s Name:

Position(s) being sought:

President-Elect: three-year term – President-Elect, President and Immediate Past President

Secretary: one-year term

Treasurer: two-year term

Regional Director: one-year term

Serving in the role of a CIVSA Executive Board member or Regional Director provides an outstanding leadership opportunity for members to gain professional growth for themselves as well as national visibility for your institution. As an Executive Board member or Regional Director, your employee will be expected to devote their time and energy to the success of the Association, so your support as the nominee’s supervisor is vital to the success of the nominee and CIVSA.

If elected, the nominee will be required to be available for at least one phone conference call per month. Additional conference call meetings are required as needed. The nominee will be required to attend the CIVSA Midyear Meeting held in November/December and the Annual Conference held in May / June. For Executive Board Members and Regional Directors, CIVSA will provide a one-time reimbursement for travel of up to $400 in accordance with the CIVSA travel policy for attendance at the Midyear Meeting and Annual Conference – all other fees are to be covered by the nominee and/or their institution. We encourage you to learn more about the job responsibilities of the position being sought in the CIVSA Operations Manual which can be found at http://www.civsa.org/about- us/bylaws/.

To be completed by the nominee’s supervisor:

I/We support the nomination of for a position on the CIVSA Executive Board or as Regional Director. I believe he/she is capable of fulfilling the duties of an Executive Board or Regional Director position and has my complete confidence and support. Additionally, I/we will support the time commitment necessary if he/she is elected to the position. I/We also understand the travel commitments necessary and agree to support him/her to attend the CIVSA required events/meetings.

Signature: Date:

Printed Name:

Title:

Institution:

Email: Office Phone:

This Statement of Institutional Support must be e-mailed to nominations@civsa.org by January 13, 2017

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