Executive and Advisory Board Nomination Form

STEM XPOSURE 2024 EXECUTIVE BOARD AND ADVISORY BOARD NOMINATION FORM
Nominee's Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Work
Position/Title
Employer Name

First NameLast Name
Employer Phone
Please enter a valid phone number.
Employer Email
example@example.com
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please select one position.
Executive Board Position Title
Advisory Board Position Title
Does the nominee have any board member experience?

YesNo
If yes, please provide the following
Company Name
Position/Title
Duration
Why do you think this Nominee should win the position?
What are the strengths of the Nominee?
What are the related skills of the Nominee?
Does the nominee/candidate have the following experience? Please select all that apply:

AccountingAdministrationBusinessEducationFinanceFundraisingLegalNon-profit managementManagementPublic RelationsOther
What can the Nominee add to the company by being member of the board?
Are you nominating for yourself?

YesNo
- I have read the responsibilities assigned for the position and I'll do my best to implement them.
- I confirm that I don't have any conflict of interest or potential that will be a hinderance in joining the board.
- I confirm that I will perform my duties as a board by committing to it.
Signature
Date Signed

MonthDayYear
Date
If no, fill up the following details:
Your Name

First NameLast Name
Your Phone
Please enter a valid phone number.
Your Email
example@example.com
Does the candidate know what you are nominating him/her?

YesNo
Signature
Date Signed

MonthDayYear
Date
Should be Empty:

STEM XPOSURE 2024 EXECUTIVE BOARD AND ADVISORY BOARD NOMINATION FORM

Nominee's Information