2022 Nomination Form for Third Regional Chair

2022 Nomination Form - Regional Chair

Third Region
Per KSBA bylaws, to be considered for election, this nomination form must be completed and submitted no later than 15 business days before your regional meeting. The deadline for your nomination form is September 30, 2022. Your Regional Secretary, who is the superintendent of your regional meeting's host district, will automatically receive your nomination form when you click the “Submit Nomination” button at the conclusion of this form.

If you are unsure which region your district is assigned to, you may view a list of regions on KSBA's website (https://www.ksba.org/KSBARegionsbyBoardMembership.aspx) or you may contact Beth Pritchett at 502-783-0063.

Thank you for your interest in serving the association and your fellow school board members across the state.
Name *

First Name Middle initial Last Name
Mailing address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home phone *
Please enter a valid phone number.
Mobile phone *
Please enter a valid phone number.
Business phone
Please enter a valid phone number.
Email *
example@example.com

Please complete all appropriate sections for consideration by at-large committee.
Primary occupation *
If applicable, you may enter "retired," "stay-at-home caregiver", "unemployed," etc.
Education background *
Please list any degrees, certifications, etc. attained.
Professional experience *

Local leadership experience
Please select the school district/board of education on which you serve. *
Dates of local school board service (including current term) *
(ex: 2015 - present)
When does your current term expire (month and year)? *
(Example: Dec. 2024)
List positions you have held on your local school board as well as the years during which you held those positions.
(i.e. Member, Chair, Vice Chair, Committee Chair, etc.)

Please provide examples of local leadership experience in your community.
(i.e. church officer, government experience, chamber of commerce, youth organizations, volunteering, etc.)
(Optional) Please share any other experience or information that you feel adds to your qualifications for this position.
Should be Empty:

2022 Nomination Form - Regional Chair