SVC-CAMFT Board of Director Application

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Email *

First name
*

Last name
*

Home address
*

Business address
*

Phone number
*

Occupation *

Relevant degree (s)
*

Number of years as an SVC-CAMFT chapter member
*

Number of years as a CAMFT member
*

Select the position (s) you are interested in
*

President

President-Elect

Treasurer

Secretary

Membership Chair

Sponsorship Chair

3000 Club Chair

Volunteer Chair

Diversity Chair

Required

List all licenses you hold and the date each license was issued. You do not have to be licensed to be a member of the board, except for the position of president and president-elect. (Note: You are considered licensed if you hold an active, inactive, delinquent or retired license.) *

Describe your past and current activities within SVC-CAMFT or CAMFT. *

Describe any community activities you are or have been involved in, including the offices held. *

What are the reasons you would like to serve as a member of the SVC-CAMFT Board of Directors? *

What strengths do you have in your background and/or experience that are relevant to your candidacy? *

What aspect of being a board member will help you meet your personal or professional goals? *

What SVC-CAMFT programs/activities interest you and why? *

What aspects of the office you seek are most and least attractive to you? *

Are you a party to any litigation, or are you or have you been involved in any other legal proceeding that may adversely affect the Association or the profession, should you be elected to serve on the Board? *

Yes

Has any licensing board, regulatory body, or ethics/peer review committee of a professional association ever taken any disciplinary action against you or a license/registration/certification held by you? *

Yes

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