Nomination Form for Elected Office

The Nominations & Leadership Committee uses this information to establish the preliminary slate for elected governance positions and appointments to committees and task forces. You may nominate yourself or another colleague. All nominees must be a member in good standing of the WLA Chapter. **Nominees will also be asked to complete a Biographical Fact Sheet to be considered for selection.

First Name
Last Name
 
Credentials
WLA Member Email
 
Street
City
 
State
Zip code
 
Phone
Email
 
Ethnicity
  •  African American
  •  American Indian/Native Alaskan
  •  Puerto Rican
  •  White
  •  Other Hispanic/Latino
 
Identify Role
 
Expertise Area (Enter comma separated value )
 
 
Name of Nomitator (if other than nominee)
 
Phone
Email