2025 Board of Regents Nominations Form

Board of Regents Nomination Form
Thank you for your interest in serving on the ACPM Board of Regents! Serving on the Board is a rewarding experience and an opportunity for personal and professional growth and for shaping the future direction of the College. Nominations are currently being accepted to fill terms beginning in May 2025. The following positions are open for nominations: President-Elect and Regent (2).

All ACPM Fellows in good standing are welcome to nominate themselves or colleagues for a Board position. The Nominations Subcommittee reviews all nominations and presents a slate of candidates to the ACPM membership for vote based on leadership competencies presented in the application and alignment with the current needs of the Board.

Nominations will be accepted until July 29, 2024. Please complete the following application for consideration. If you are nominating a candidate, you do not need to complete Section 2 – Collective Skills/Competencies. The nominee will be asked to complete this section once nominated.

NOTE: The work of the Board is guided by ACPM’s bylaws, strategic plan and Code of Ethics to assure the highest level of professionalism for the College and the membership in the practice of preventive medicine. All nominees are requested to review these documents.

Section 1: Candidate Information and Interest

1. Candidate First Name *This question is required.

2. Candidate Last Name *This question is required.

3. Title

4. Organization

5. Email *This question is required. This question requires a valid email address.

6. Select the position(s) for consideration: *This question is required.

President-Elect
Regent (2 positions)

7. Specialty Discipline & Board Certification:

Aerospace Medicine
Occupational Medicine
Public Health and General Preventive Medicine

8. Work Setting: *This question is required.

9. Why are you (or the nominated candidate) interested in serving on the ACPM Board of Regents? What do you hope to gain from the experience? 2,500 character max

10. How do you feel ACPM would benefit from your (or the nominated candidate's) involvement on the Board? 2,500 character max

11. Current CV/Resume *This question is required.

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Section 2: Collective Skills/Competencies

The Nominations Committee will use the following skills/competencies information to align with the needs of the Board. Since the committee looks for a broad range of skills, it is not necessary for candidates to have experience in all competency areas.

Which of the following skills and expertise can you offer to the Board? (Check all that apply.)

12. Leadership:

13. How have you demonstrated the leadership skills and expertise noted above? (Describe the roles and experiences where these attributes were best applied.) 2,500 character max

14. Professional:

Research
Education of Medical Students/Residents/CME/Other
Policy
Program Development, Implementation and Evaluation

15. How have you demonstrated the professional skills and expertise noted above? (Describe the roles or experiences where these attributes were best applied.) 2,500 character max