National Black Presbyterian Caucus Nomination Form
PCUSA
Use this form to self nominate or if you want to nominate someone else.
Are you self-nominating or nominating someone else to serve
*
I am nominating myself
I am nominating someone else
If you are nominating someone else, has that person been contacted?
Please Select
YES
NO
If you are nominating someone else what is your name?
Name of Nominee
*
First Name
Last Name
Email for nominee
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What Chapter Are You In?
*
Select the office this application is for.
*
Vice President
Secretary
What interests you about this role, and what are the gifts, experiences or interests that will help you serve in it?
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What do you need us to know to help you serve in this role?
*
Upload Your Resume or Bio Here
*
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