ICA Board of Directors Nomination Application

INDIANA COUNSELING ASSOCIATION

BOARD OF DIRECTORS NOMINATION APPLICATION
*Note: All ICA Board of Directors positions run for 1-year terms (July-July), with exceptions of the President and Treasurer that serve for 2-year terms.

According to our current Bylaws, all Executive Board and Committee positions require that applicants go through the formal election process. All other applications for Professional-Interest Division and Representative positions can submit their resume or CV to the President and Executive Director (execdirector@indianacounseling.org). The President and Executive Director will then present the resume or CV to the Board of Directors for approval.

All Nomination applications must be submitted by May 1, 2021.
Name and Demographics
Name *

First Name Last Name
City/Town *
State *
Email address *
example@example.com
Phone number *
Are you an ICA Member? *

Yes No
Membership Expiration Date

Month Day Year
Date
Education and Licensure
What is your highest degree obtained or presently working toward? *
Major Course of Study *
Institute(s) of Higher Education *
Graduation Date (if a student, please list projected graduation date):
Are you licensed as a professional counselor? *

Yes No
If yes, what license do you hold?
What is your counseling specialty area? (For example, multiculturalism, advocacy, autism, play therapy, couples and families, children with disabilities, education, etc). *
Nomination
Source of Nomination *

Self-nomination Nominated by someone else
Nominated by: *

First Name Last Name
ICA Position(s) for which this person is applying/nominated (Please select all that apply) : *

President-Elect Committee Chair Legislative, Membership, or Treasurer Committee Chair (Legislative, Membership, or Conference/Education)
For Committee Positions (please select one)

Legislative Committee Chair Membership Committee Chair Conference/Educatior Chair
Statement of Interest (Describe why you are nominating yourself or another member to this position.) *
Skills/Qualifications (Describe any special skills that especially qualify the individual for this position.) *
ICA Statement of Commitment *

I confirm that the above information is accurate and the person aforementioned is committed to the applied position.
All Nomination applications must be submitted by July 1, 2021. Applications can be emailed to execdirector@indianacounseling.org.

*If you are applying for the President-Elect position, you may choose to include a CV or a 2-page vitae with background and qualifications with your application.

For further questions, please contact execdirector@indianacounseling.org
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INDIANA COUNSELING ASSOCIATION

Name and Demographics

Education and Licensure

Nomination