American Cochl



3604260000American Cochlear Implant Alliance Board of Directors Nomination FormACI Alliance is pleased to announcea new opportunity to become a board member for the American Cochlear Implant Alliance (ACI Alliance). Specifically, we are seeking nominations for individuals who would have a positive impact on the organization from a leadership standpoint. That individual might be yourself or another person whom you would like to nominate.? We welcome and encourage nominations from or for any individual who has relevant cochlear implant experience, including, but not limited to those who are surgeons, audiologists, speech pathologists, educators, auditory therapists, psychologists, social workers, parents or recipients.?Name/Credentials: Click here to enter text.Email Address: Click here to enter text.Phone Number: Click here to enter text.Employer: Click here to enter text.Position: Click here to enter text.Other Relevant Experience: Click here to enter text.Skills: Click here to enter text.Professional/Civic Membership: Click here to enter text.What topics or issues are you interested in working on if you were selected for the Board of Directors?Click here to enter text.Why would you be a good board member?Click here to enter text.What contributions have you made to ACI Alliance? For example, have you presented your research at a conference? Served on a committee? Participated in advocacy as a State Champion or as part of ACI Alliance on the Hill?Click here to enter text.What ACI Alliance conferences have you attended (please note by year and location)? Click here to enter text.Please discuss your service and involvement with related professional organizations?Click here to enter text.Agreement and SignatureResponsibilities of board membership include attending the annual ACI Alliance conference, in-person board meetings, conference calls, and participation on various board initiatives.? All expenses associated with being on the board are the responsibility of the individual.?Submitted By Name: Click here to enter text.Date: Click here to enter text. Email: Click here to enter text. Phone Number: Click here to enter text. Has this person been contacted and approved this nomination: Click here to enter text.ACI Alliance PolicyIt is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.If you are interested or would like to nominate an individual, please fill out and return the attached nomination questionnaire no later than December 6, 2019 to Jessica Houk (jhouk@). The Board Nominations Committee will review and discuss the nominations and select individuals to fill the board vacancies. ? ................
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