2025 HUMAA Board Nomination
Your responses will be used when publicizing the slate of nominees.
Name
First Name
Last Name
Email
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Phone Number (Identify Home, Cell, Work)
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Howard University College of Medicine Class
Undergraduate
Specialty
Residency
Employer
Current Practice
Please Select
Active (40 hours)
Semi-Retired
Retired
List any service activities to HUMAA
Back
Next
List any service activities to Howard University and/or the College of Medicine
Nonprofit Board Service-Are you currently serving, or previously served on a nonprofit board? Please share your experience.
Please describe why you would like to join the HUMAA Board of Directors?
What assets will you bring to the HUMAA Board of Directors?
If elected, which committee(s) would you be interested in joining?
Budget, Finance and Audit (BFA), Membership Engagement, Fundraising, Scholarship,
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I certify that all the information that I have provided in or in connection with this Questionnaire is correct and complete to the best of my knowledge. I acknowledge that all Board members shall maintain a high level of professional conduct, as well as personal and professional integrity. I shall preserve all confidential information during my tenure in office and avoid all conflicts of interest. I shall declare any condition (physical, psychological, legal or otherwise) that will impair my service to the Board. I further agree to notify HUMAA in a timely manner (not to exceed 30 days) any change(s) in this information during the candidate process or during my tenure as a board member, should I be elected.
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