Community Delegate Nomination Form
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Work
Position/Title
Does the nominee have any board member experience?
Yes
No
Please briefly describe why you are interested in serving as a MCA Community Delegate (200 words or less)
*
What are the strengths of the Nominee?
Does the nominee/candidate have the following experience? Please select all that apply:
*
Accounting
Administration
Business
Education
Finance
Fundraising
Legal
Non-profit management
Management
Public Relations
Other
Are you nominating for yourself?
Yes
No
Agree to attend monthly meetings?
Yes
NO
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
*
-
Month
-
Day
Year
Date
If no, fill up the following details:
Your Name
First Name
Last Name
Your Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email
example@example.com
Does the candidate know what you are nominating him/her?
Yes
No
Signature
Date Signed
-
Month
-
Day
Year
Date
Upload your headshot here
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Submit
Should be Empty: