2022 Board of Directors Candidate Application
Thank you for your interest in the Board of Directors of the New Mexico Alliance for School-Based Health Care (NMASBHC).  Please complete the following questionnaire so that we can make the best use of your talents and expertise and offer you the most rewarding experience as a member of the Board. Please update staff if your place of employment, address, etc has changed during your term.

Please provide this completed application, your resume or curriculum vitae, a biosketch and three references by email to Nancy Rodriguez (nancy@nmasbhc.org) by March 18, 2022.
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Email *
Name (First & Last)
Credentials
Mailing Address
Business Phone
Mobile Phone
Email Address
Place of Employment (or, if retired, last employer)
Please summarize your educational and professional history. Please highlight your work to support children's health, school-based health care and/or work in school.
Please state why you are interested in being on the NMASBHC Board of Directors.
Please describe current barriers to access to health care for students in New Mexico.
How many hours could you contribute to the organization, on average, on a monthly basis?
On which standing committee(s) are you interested in serving?
Are you interested in taking on a leadership role, either now, or in the future?
Please describe your experience on other boards, if any, on which you serve, or have served in the past.
Demographic Information
Demographic Information (requested).  Please let us know your category of age. According to the NMASBHC by-laws, we must have two Directors who are between 18 and 35 years of age.
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Age (optional)
What is your gender identity? (optional)  
Race
Skills and Experience Inventory - Special Skills. Please select any skills which describe you:
Skills and Experience Inventory - Field Based Experience. Please select any skills which describe you:
Geographic Location - Please describe the area of the state in which you currently live
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