2027 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 2027. The following positions are open for nominations: President-Elect and Regent At-Large (2).

All ACPM Fellows in good standing are welcome to self-nominate or be nominated for a Board position. The Nominations Subcommittee reviews all nominations. A ballot is presented to eligible ACPM members for vote based on leadership competencies presented in the application and alignment with the current needs of the Board. The ballot consist of at least two candidates for President-Elect and four candidates for Regent At-Large. One nominee can be presented for a position if he/she is unopposed.

Nominations will be accepted until July 16, 2026. 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

2. Candidate First Name *This question is required.

3. Candidate Last Name *This question is required.

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

5. Title

6. Organization

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

President-Elect
Regent At-Large (2 positions)

8. Specialty Discipline & Board Certification:

Aerospace Medicine
Occupational Medicine
Public Health and General Preventive Medicine
Other - Please Specify Please enter an 'other' value for this selection.

9. Work Setting: *This question is required.

Government
Military
Academia
Corporate
Community/Nonprofit
International
Other - Please Specify Please enter an 'other' value for this selection.

10. 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

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

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

File: {{filename}} delete

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:

14. 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

15. Professional:

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

16. 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

Section 3: Nominator Information

Nominator First Name *This question is required.

Nominator Last Name *This question is required.

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