Nomination Form 2023

Candidate Profile
NCHEC is searching for individuals to fill volunteer positions on our Board of Commissioners and Division Boards. All positions adhere to the Code of Ethics of the Health Education Profession. NCHEC welcomes all CHES® and MCHES® in good standing to apply for open positions on our volunteer boards. As we strive to have our board directors reflective of the individuals we serve, we encourage individuals from all backgrounds of race, ethnicity, religion, sex, gender identity, age, disability, and sexual orientation to submit a nomination form. NCHEC seeks individuals from a variety of practice settings including; schools, healthcare, business/industry, academia and community.

Elections will be held in August 2023. The terms of these positions will begin on January 1, 2024. Consider nominating yourself or encouraging a peer to take this opportunity. The deadline to receive completed nomination forms is June 1, 2023.
Directions: To be considered as a candidate for an NCHEC Board you must:

1. be a CHES® or MCHES® in good standing.

2. be willing to serve a five-year term to support the work and mission of NCHEC.

3. be willing to protect confidentiality, and avoid conflict of interest.

DEADLINE: Submit this form by June 1, 2023.
Form Instructions

Complete the form in full. State information clearly and succinctly. No attachments will be accepted. DO NOT USE ABBREVIATIONS. All personal information will be confidential within NCHEC. SIGNATURE IS REQUIRED.
I. Candidate Information
Name*

PrefixFirst NameLast NameSuffix
CHES® or MCHES® (MCHES® certification required for a DBCHES position)*
Certification Number*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number*

Area CodePhone Number
Employer Name*
Title/Position*
Business Address*

Street Address

Street Address Line 2

CityState

Zip Code
Preferred Mailing Address*

HomeWork
Business Phone Number

Area CodePhone Number
Home Email*
example@example.com
Work Email
example@example.com
Preferred Email Address*

HomeWork
EDUCATION (Highest Degree Earned)*
In what type of organization do you spend the majority of your work time as a health education specialist?*

HealthcareSchoolUniversityCommunityWorkplaceRetiredOther
If you selected other or retired to the above profession, please use the space below to explain your affiliation with the health education profession.
What gender do you identify with?
If your gender is not listed above, please type it in.
What is your race and ethnic background?*
Are you of Hispanic, Latino, or Spanish origin?*
How many years have you worked in the health education profession?*

1 - 56 - 1011 - 1516 - 2020+
In what geographic region do you reside?*

Northeast (Maine, Massachusetts, Rhode Island, Connecticut, New Hampshire, Vermont, New York, Pennsylvania, New Jersey, Delaware, Maryland)Southeast (West Virginia, Virginia, Kentucky, Tennessee, North Carolina, South Carolina, Georgia, Alabama, Mississippi, Arkansas, Louisiana, Florida)Midwest (Ohio, Indiana, Michigan, Illinois, Missouri, Wisconsin, Minnesota, Iowa, Kansas, Nebraska, South Dakota, North Dakota)Southwest (Texas, Oklahoma, New Mexico, Arizona)Northwest (Colorado, Wyoming, Montana, Idaho, Washington, Oregon, Utah, Nevada, California, Alaska, Hawaii)
Please consider my nomination for the following position in 2024:*

Board of Commissioners (BOC)Division Board for Professional Development (DBPD)Division Board for Professional Preparation and Practice (DBPPP)Division Board for Certification of Health Education Specialists (DBCHES)
Information on the role of the various NCHEC Division Boards and Board of Commissioners can be found here: https://www.nchec.org/vision-and-mission.

Professionals aligned with the Commission and/or the Division Boards must avoid ethical, legal, financial and other conflicts of interest, and ensure that their activities and interests do not conflict with their obligations to the Commission or its welfare. Any questions regarding potential conflicts of interest should be directed to the Deputy Executive Director or the Vice-Chair of the Board of Commissioners.

The mission of NCHEC is to enhance the professional practice of Health Education by promoting and sustaining a credentialed body of Health Education Specialists. To meet this mission, NCHEC certifies health education specialists, promotes professional development, and strengthens professional preparation and practice.
II. Candidate Interest/Experience Statement

Directions: Please type a brief (maximum of 100 words) response for each item under the Specific Board ONLY to which you have applied. *Please note the information given will be used as a basis for the candidate biography that accompanies the ballot.
BOC (Responsible for governing and accountability of all NCHEC activities). Please briefly describe your Interest and/or Experience in:
1. Strategic planning/budget and finance approval. (100 word max)
2. Communication and coordination of governing boards. (100 word max)
3. Health education and health education credentialing. (100 word max)
4. Non-profit board function. (100 word max)
5. Demonstration of the commitment to diversity, equity, inclusion and non-discrimination/bias. (100 word max)
DBPD (Responsible for recertification and annual renewal process). Please briefly describe your Interest and/or Experience in:
1. Recommending policies and procedures related to continuing education providers. (100 word max)
2. Recommending fees (100 word max)
3. Assurance- monitoring and evaluating processes for certification maintenance (100 word max)
4. Development and delivery of health education continuing education programs (100 word max)
5. Demonstration of the commitment to diversity, equity, inclusion and non-discrimination/bias. (100 word max)
DBPPP (Responsible for promoting professional preparation). Please briefly describe your Interest and/or Experience in:
1.Working with colleges, universities, or accrediting agencies (100 word max.)
2. Credentialing processes (100 word max.)
3. Professional preparation (100 word max.)
4. Eligibility review processes (100 word max.)
5. Demonstration of the commitment to diversity, equity, inclusion and non-discrimination/bias. (100 word max)
DBCHES (Responsible for the entry and advanced level credentialing examinations. MCHES® certification is required). Please briefly describe your Interest and/or Experience in:
1. Review and evaluation of examination processes (100 word max.)
2. Item writing and examination construction. (100 word max.)
3. Examples of working independently and learning new skills. (100 word max.)
4. Advanced health education practice (i.e. research, administration, leadership) (100 word max.)
5. Demonstration of the commitment to diversity, equity, inclusion and non-discrimination/bias. (100 word max)
III. Resume/Curriculum Vitae
Please upload a resume/vitae for consideration.*

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IV. Commitment to Serve on an NCHEC Board.
By signing this document, I attest to:

If elected, I recognize the important responsibility I am undertaking in serving as a Commissioner and/or Director of the National Commission for Health Education Credentialing, Inc. (NCHEC). I hereby will carry out, in a trustworthy and diligent manner all the duties and obligations inherent in, my role as a Board of Commissioner and/or Division Board Director. I understand that I am accepting a 5 year commitment to serve on a NCHEC Board that involves my attendance at a minimum of one face-to-face meeting each year. I further understand that reasonable travel expenses to attend meetings will be reimbursed by NCHEC. I have notified my employer that I have submitted a nomination for this position.

MY ROLE
I acknowledge that my primary role as a Commissioner and/or Director will focus on the development and fulfillment of the organization’s strategic plan, policies, and procedures that are consistent with the direction of the NCHEC’s mission and vision statements while protecting confidentiality, and avoiding conflict of interest.

MY COMMITMENT
I will exercise the duties and responsibilities of this appointment with integrity, collegiality, and due care by:
- Maintaining my CHES®/MCHES® certification.
- Attending all meetings of the NCHEC Board to which I am elected, including at least one face-to-face meeting annually.
- Being prepared to contribute to the discussions of issues and business to be addressed at scheduled meetings, having read the agenda and all background support materials relevant to the meeting.
- Completing all assignments within time frames established by the Board.
- Exercising independent judgment on decisions and maintain confidentiality.
- Advocating for credentialing.
- Abiding by the bylaws, policies and procedures of the organization.
Signature*

Clear
Date of Signature*

MonthDayYear
If elected, I agree to serve.*
Should be Empty:

Candidate Profile

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