Call for Nomination

BOARD OF DIRECTORS CANDIDATE PROFILE
Name and Title*

First NameLast NameTitle
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Number

Area CodePhone Number
Position Title in current job*
Community / Civic*
Professional Involvement*
Current Projects*
Personal Statement regarding possible contributions to PNAA Foundation (not to exceed 250 words):*
Interested to run for the following positions (double left click on the box):*

PresidentPresident ElectVice PresidentSecretaryAssistant SecretaryTreasurerAssistant TreasurerAuditorBoard Member
Attach your headshot photo*

Browse Files

Cancelof

CONSENT TO SERVE
Consent*

I have read and understood the By-Laws of the Philippine Nurses Association of America Foundation, Inc. (PNAAF).I am willing to serve as an officer/member of the Board of Directors on my own free will if elected to the position.I am aware of my responsibilities and I will abide by the rules and regulations of the Philippine Nurses Association of America Foundation, Inc.
Signature*

Clear
Date*

MonthDayYear
Date

CONFLICT OF INTEREST
Name*

First NameLast Name
Position*

Board of DirectorOfficerCommittee member
1. Have you or any of your family members provided services or property to the following this year? If yes, please describe the nature of the services or property that was provided:*
2. Have you or any family member of yours purchased services or property from PNAAF in the past year? If yes, please describe the nature of the services or property that was purchased: *
3. Please indicate if you or any of your family members have had any direct or indirect interest in any business transactions in the past year where PNAAF was an interested party? If yes, please describe the nature of the business transaction:*
4. Were you or any of your family members indebted to pay money to PNAAF at any time in the past year? If the answer is yes, please describe the nature of the indebtedness: *
5. In the past year have you or any member of your family become entitled to receive any personal benefits from PNAAF or as a result of your relationship with PNAAF?*
6. That an aggregate amount of more than $1,000 that was not a result of compensation was given to you by PNAAF that was not directly related to your duties? If the answer is yes, please describe the nature of the benefit: *

ATTESTATION
Attestation:*

I hereby confirm that I have read and fully understand PNAAF Conflict of Interest Policy and my responses found above are complete and correct to the best of my belief and knowledge.I agree that if I become aware of any information that may indicate that there were incorrect disclosures made above that I will notify PNAAF Board of Directors immediately.
Signature*

Clear
Date*

MonthDayYear
Date

Subject: Nomination & Election	Policy #:030216 D
Effective Date: March 3, 2016	Submitted By: Annie A. Vista (Chair), Amor Castro (Adviser) Reviewed by: Merlita A. Velasquez, Rose P. Estrada, Mindy Ofiana, Rose Santee, Sue Repotente (Members)
Approved Date: March 2, 2016 Revision Date: March 17,2017 Revised Date: June 4, 2021 Revised Date: April 18, 2023	Approved By: Board of Directors

ATTESTATION