CLCC 2026–2027 Commissioner Application
Application form for individuals seeking to serve as a commissioner for the Child Life Certification Commission (CLCC) during the 2026–2027 volunteer cycle. Please complete all required sections and upload the necessary documents. *To be considered, please submit an application along with a letter of recommendation and your resume or CV by 11:59 pm CDT April 17, 2026.
Full Name
*
First Name
Last Name
E-mail Address
*
example@example.com
Position(s) for Consideration
*
Please Select
Commissioner
Chair-elect
Treasurer
Geographical Location
*
Please Select
Northeast (CT, DC, DE, MA, MD, ME, NH, NJ, PA, RI, VT)
Southeast (AL, AR, FL, GA, KY, LA, MS, NC, SC, TN, VA, WV)
Midwest (IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, WI)
Southwest (AZ, NM, OK, TX)
West (AK, CA, CO, HI, ID, MT, NV, OR, UT, WA, WY)
Canada - Alberta
Canada - British Columbia
Canada - Manitoba
Canada - New Brunswick
Canada - Newfoundland and Labrador
Canada - Nova Scotia
Canada - Ontario
Canada - Prince Edward Island
Canada - Quebec
Canada - Saskatchewan
Certification Number
*
Years Certified
*
Please Select
0-5 Years
6-10 Years
11-15 Years
16-20 Years
21+ Years
Highest Degree Earned
*
Job Title
*
Workplace
*
Briefly describe your current role.
*
Current Primary Work Setting
*
Please Select
Large Hospital Program (greater than 15 FTEs)
Medium Hospital Program (6-15 FTEs)
Small Hospital Program (less than 5 FTEs)
Single Person Program
Community Based Practice, including Private Practice or non-traditional role
Academic Full-time
Academic Adjunct
Other
If Other Primary Work Setting, please specify.
Roles Worked (select all that apply)
Adjunct professor
Internship supervisor
Internship coordinator
Community Type
*
Please Select
Large City
Mid-size City
Small City
Rural
Have you served or are you currently serving on a board or committee for CLCC, ACLP, or another child life organization?
*
Yes
No
If yes, please provide details about your board or committee service.
Interest Statement: Why are you interested in serving on the Child Life Certification Commission?
*
What primary challenges and opportunities do you think the CLCC faces in the next few years?
*
What unique experiences and/or perspective would you bring to service on the Commission?
*
What related skills or experiences do you have that would assist you in this role?
*
Is there anything else you want the nominating committee to know?
Are you able to commit to the time required to serve?
*
Yes
No
Possibly, but need to confirm with my supervisor
If selected to serve, are you able to sign confidentiality and conflict of interest forms?
*
Yes
No
Gender Identity
Please Select
Male
Female
Non-binary/Non-gender Conforming
Prefer not to answer
Other
If Other Gender Identity, please specify.
Racial/Ethnic Background (select all that apply)
African American / Black
Asian / Pacific Islander
Caucasian / White
Hispanic / Latino / Latinx
Indigenous
Other
If Other Background, please specify.
If you are not selected for a role on the Commission, may we contact you about opportunities to serve on other CLCC committees?
Yes
No
Upload Letter of Recommendation
*
Upload a File
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Choose a file
Cancel
of
Upload Resume or CV
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
I attest that I meet all eligibility requirements to serve as a CLCC Commissioner.
*
I attest I meet all eligibility requirements.
If applying for Chair-elect: I acknowledge I have at least two years of prior CLCC committee service experience.
I acknowledge I have at least two years of prior CLCC committee service experience.
Submit Application
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