East Bay CAMFT - Board Application
Email *
Name *
Relevant degree(s)
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Home Address *
Business Address *
Phone Number *
Email
Are you a current member of CAMFT and EB-CAMFT?
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Indicate your professional status below *
Executive Committee positions are elected by chapter members through a vote. If you are interested in running for an Executive Committee position, please check all of the positions that interest you. See here for job descriptions.
The following board positions are appointed by the current Board of Directors. Check each board position that you are interested in applying for. 
If you selected "other" from the above list, please write in which board position you are applying for. 
Are you aware of any complaint or accusation filed against you by a licensing board, or 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?
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If your answer is "yes" to the above question, please explain.
Has any licensing board, regulatory body, or professional association's ethics committee ever taken any action against you, your license, your registration or your membership?
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If your answer is "yes" to the above question, please explain.
List past and current board positions or activities within EB-CAMFT, CAMFT, or other CAMFT Chapters
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Community activities, including offices held
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Special interest in your clinical practice
What are the reasons you would like to serve as a member of the Board of Directors of
EB-CAMFT and in the position for which you are applying?
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What strengths, skills or experience do you have in your background that are relevant to your candidacy?
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What aspect of being a board member will help you meet your personal goals?
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What aspects of the office you seek are most and least attractive to you?
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What EB-CAMFT programs/activities interest you and why?
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What new programs/activities would you like to see EB-CAMFT embark upon? What do you think would make EB-CAMFT more effective?
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The Board primarily meets on the second Friday of the month. Please select your time preference for the meeting. *
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