Board of Directors Position Application

2024 Board of Directors Application
Prior to completing this application, please familiarize yourself with the following resources created by the Leadership Development Committee:
If you have any questions about this process, please reach out to the Chair of the Leadership Development Committee, A. Jill Clemence at ajillclemence@rrmc.org or the SPA Executive Director, Nathan Victoria at nvictoria@spaonline.org.

Application Deadline: July 7, 2024

Please note, the materials submitted will be accessible by the Leadership Development Committee only. If you are selected to be on the Election Slate, you will have the ability to edit your statement that will accompany the full membership ballot.
Name*

First NameLast Name
Work Position Title *
Organization/Institution *
Email*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
Ballot Name if different from your first and last name above.
Name as you would like it to appear on the election ballot. Note: Credentials will NOT be included.
Brief Individual Bio*

300 Words Maximum 0/300
Describe your interest in serving on the SPA Board of Directors. Please also indicate your previous experience with the responsibilities as outlined in the job descriptions for the positions you are applying. *

400 Words Maximum 0/400
SPA Board Member Competencies

The Leadership Development Committee has identified 7 competencies of ideal board members. Please access the link to see more information about the competencies.
Please select the top three competency areas you would bring to the SPA Board of Directors.*

Knowledge of SPA and Personality AssessmentStewardship and GovernanceOpenness/IntegrityStrategic Thinking/Direction SettingJudgement/Problem SolvingLeadership ExperienceRelationship Building/Connectedness
Diversity, Inclusion, Equity, and Justice are key tenets that SPA is centering in its future work. Please address how diversity, inclusion, equity, and justice informs both your professional work and SPA’s future work.*

300 Words Maximum0/300
Please upload a current copy of your resume/c.v., in particular highlighting your volunteer experiences with SPA and allied organizations/societies.*

Please upload in PDF
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Position Description Confirmation: By checking the box, you are confirming you have read the position description(s) prior to submitting your application.*

YES, I have read and understood the position description of the position(s) for which I am applying.
Fiduciary Duties Confirmation: By checking the box, you are confirming you will comply with the general and fiduciary (duties of care, loyalty, and obedience) responsibilities of SPA volunteer leaders.*

YES, I have read, and, if elected, I agree to comply with the general and fiduciary (duties of care, loyalty, and obedience) responsibilities of SPA volunteer leaders as outlined in the Candidate Leadership Guide.
Term Confirmation: By checking the box, you agree to the term of office and have support from your leadership/supervisor (if applicable) to serve on the SPA Board.*

YES, I have read, and, if elected, I agree to the term of office and have, if applicable, support from my leadership/supervisor to serve on the SPA Board.
Reference Request: As explained on the website, the Leadership Development Committee will review all applications, and they will move a select few to a finalist stage for interviews with the SPA Presidential Trio. At this stage, the committee may also reach out to a list of references you will provide by June 30 in a separate form. By checking the box, you are confirming you will provide a list of references to SPA staff when requested.*

YES, I have read, and, when requested, I will share a list of references who can speak to my skillsets.
Demographic Information

SPA is dedicated to creating an intentionally inclusive Society that does not discriminate on the basis of all identity dimensions, which include, but are not limited to, ability, age, ethnicity, gender identity and expression, immigrant status, national origin, race, religion, sex, sexual orientation, socioeconomic status, and veteran status. We welcome applications from all individuals that meet the application requirements. Feel free to indicate multiple boxes where applicable.

We are inviting you as the applicant to self-identify along any and all of these following demographic dimensions. The information provided will only be seen by the Leadership Development Committee, and we will utilize this information to ensure the applicant pool represents the full diversity of our membership. Any report of the applicants will be shared in aggregate form, and no personally identifiable information will be connected to the demographics.
Approximately how long have you been a member of SPA? *
Please list your current country of residence.*
What is your assessment area activity? Please select all that apply.*

AdministrationConsultationPractitionerResearchStudentSupervisionTeachingOther
Please let us know in what areas you supervise supervisees. Select all that apply.*

EducationalForensicHealthI/OInpatientNeuropsychologyOutpatientOther
Please let us know in what areas you practice. Select all that apply.*

AdministrationEducationalForensicHealthInpatientI/ONeuropsychologyOutpatientOther
Gender Identity*

CisgenderGender Queer/Gender Non-ConformingManTransgenderWomanPrefer not to discloseA gender not listed; please specify in the other category if you would like to discloseOther
Race/Ethnicity*

American Indian/Alaska Native/Native Hawaiian/Pacific IslanderAsian/Asian AmericanBlack/African AmericanHispanic/Latinx/a/oMiddle Eastern or North AfricanMultiracial/MultiethnicWhite/Non-HispanicPrefer not to discloseA racial/ethnic identity not listed; please specify in the other category if you would like to discloseOther
Sexual Orientation*

BisexualGayHeterosexual/StraightLesbianPansexualQueerPrefer not to discloseA sexual orientation not listed; please specify in the other category if you would like to discloseOther
Disabilities*

N/ABlind/Low VisionChronic IllnessDeaf/Hard of HearingLearning DisabilityPhysical/SystemicPsychological DisabilityPrefer not to discloseA disability not listed; please specify in the other category if you would like to discloseOther
Please list any other salient identities you would like to disclose.
Confirmation of Application*
By typing out your name above, you confirm that all information in this application is accurate.
Should be Empty:

2024 Board of Directors Application