CASE Committee Consideration Form
This form may be completed by a candidate or by a nominator.  It is essential that the form is completed and contains accurate information for each candidate.  Please complete another form if you wish to nominate additional candidate(s).  Complete one form for each candidate
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CANDIDATE'S name. *
CANDIDATE'S Address *
CANDIDATE'S Telephone Number *
CANDIDATE'S Email Address *
CEC/CASE ID# *
CANDIDATE'S Gender *
Ethnicity *
Required
Type of Disability (if applicable)
Professional Role *
Required
If you responded "other" to your professional role, please explain.
What age group do you serve? *
If you selected "other" regarding the age group you serve, please explain.
In your current role are you responsible for implementing Part B of the IDEA? *
CASE Subdivision Offices Held w/Dates *
Please indicate the standing committee for which the candidate is being nominated (check all that apply) *
Required
Describe how candidate's leadership experiences, professional or volunteer, relate to the committee(s) selected. *
CASE holds equity and belonging as a key part of our work.  Please share what candidate will bring to CASE in order to help us move our DEI work forward. *
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