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2026 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 2026. The following positions are open for nominations: Secretary, Treasurer and Regent At-Large (4). 

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 ballot consisting of two candidates each for Secretary and Treasurer and eight candidates for Regent At-Large 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 28, 2025. 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.
 
1. Are you nominating yourself or another ACPM member? *This question is required.
Section 1: Candidate Information and Interest
This question requires a valid email address.
7. Select the position(s) for consideration: *This question is required.
8. Specialty Discipline & Board Certification:
9. Work Setting: *This question is required.
12. Current CV/Resume *This question is required.
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.)
 
13. Leadership:
15. Professional:
Section 3: Nominator Information
This question requires a valid email address.