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APA Component Nomination Form

APA Component Nomination Form

Thank you for your interest in serving on an APA Component. Through the generosity of members like you, the success of APA's advocacy for our patients and our profession is made possible. For more information about Councils and their components, including responsibilities and charge, please visit the APA website. 

Before you begin, please ensure you have the following information about yourself or the colleague you are nominating: 
  1. Nominee's full name and credentials; 
  2. Nominee's city, state, and country; 
  3. Nominee's contact information (e-mail);
  4. Nominee's current or past APA component service;
  5. A brief statement of interest outlining the nominee's expertise and experience in the selected area(s) of interest (max 200 words);
  6. An abbreviated CV (1-page max) tailored to the component(s) the nominee is interested in serving;
  7. A photo of the nominee
The above items are required to complete your submission.
 
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