PA Students for Leadership, Equity, Anti-Racism, and Diversity Director Application
Please complete all of the sections below if you are interested in becoming part of the National Board of Directors for PA-S LEAD. Thank you!
Name
*
First Name
Last Name
Preferred Pronouns
*
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
Program
*
Anticipated Graduation Date
*
-
Month
-
Day
Year
Date
Ethnic & Racial Identity
*
Black/African American
Latinx/Hispanic
Indigenous/Native American/Alaskan Native
Native Hawaiian/Pacific Islander
Asian
White
Other
How did you hear about us?
*
Tell us about yourself. Include past & current leadership positions, volunteer work, future plans as a PA, & relevant experiences/passions. Through these experiences, how have you promoted the values of leadership, equity, anti-racism, and diversity?
*
0/500
Why are you interested in this position?
*
0/500
Please read the roles and responsibilities of a PA-S LEAD Director.
I understand and agree to the role and responsibilities of a PA-S LEAD Director and will do my best to uphold these conditions if I accept the position.
*
I agree
Please read the PA-S LEAD Mission, Vision, and Goals.
I agree and align with the organizations Mission, Vision, and Goals. (Please sign)
*
Submit
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