To Nominate Yourself Or Another Qualified Candidate, Please Provide the Following Information

Nomination Form for 2018 Central District Leadership Council

Qualifications:

1) All candidates must reside or work in one of the Central District states, must be a current member of SHAPE America and must maintain their membership throughout their term of office.  District president will serve a three-year term (one year as president-elect, one year as president and one year as past president)  Members-at-large will serve a two-year term (three members-at-large will be elected in odd years and two will be elected in even years)  Future professionals will serve a one-year term, with the option of a second year 2) Candidates for president-elect shall have held continuous membership for three years prior to being placed on the ballot. It is recommended, but not required, that candidates have previously served at least one two-year term on the District Leadership Council, formerly called District Board. 3) Candidates for member-at-large shall have held continuous membership for two years prior to being placed on the ballot. It is recommended that candidates have previously served at the state or district level in leadership positions.

To nominate yourself or another qualified nominee, please provide the following information:

For the Office of: (please check)

___ President-elect (complete Parts A, B, C, D)

___ Member-at-Large (complete Parts A, B, C, D)

___ Future Professional (complete Parts A, B, C, E)

PART A

Name ______SHAPE Membership #______Exp

Date______Address: (H) ______Street City State Zip Code Phone (H) ______E-mail Address

______

Present Position:

______

School/Organization:

______

Phone (O) ______FAX ______

______

PART B

Attach a short vita (Word format/two pages max.) and photo (separate .jpeg with your name as file name)

PART C

Consent Form

I consent to have my name placed in nomination for the office of ______in SHAPE America Central District.

______Print Name Signature Date

* Candidates for president-elect and member at-large: Please provide a letter from your immediate superior indicating that they understand the time commitment of the office and that they will be supportive of you fulfilling these commitments.

Immediate Supervisor's Name: ______

Title: ______Email Address: ______*Candidates for future professional: Please submit one letter of recommendation from your school faculty and one letter of recommendation from a member of your state affiliate.

PART D * Candidates for president-elect and member at-large: Explain the strengths you would bring to the Leadership Council and why you want to serve. Please limit this statement to 250-300 words.

PART E *Candidates for future professional: Submit a paragraph explaining why you want to serve on the Leadership Council.

Submit materials via email to: Dennis Docheff Central District Nominations Chair [email protected]

DEADLINE: September 15, 2017