UCDA Board Member Nomination Application

Nominee Name/Title

Nominee Institution/Company

Nominee Department/Office

Nominee Phone

Nominee Email Address (Enter twice to verify)

Email Address

UCDA Experience

Professional Experience and Awards

Please select one

Yes

No

Uncertain

Select all that apply

Professional Organizations and Affiliations Involved With

Describe Briefly Why You Would Like to Serve on the UCDA Board of Directors

What Skills or Personal Qualities Will You Bring to This Role?

How Can UCDA Enhance the Professional Lives of its Members or Their Institutions?

Please include and updated résume or curriculum vitae