YAC Nomination Form

I hereby recommend consideration of the following person as a candidate for nomination to the YAC Board of Directors as a:

Please fill in the information requested below. Fields with an * are required.
*Nominee Name:  
*Title/position within agency:  
*What boards, association affiliations, director/officer roles (past and present) has this nominee served?:
*I think this person is capable of fulfilling the responsibilities of a Board member because:
*Nominator Name:  
*Nominator Agency Name:  
*Nominator Agency City:  
*Nominator Title:  
*Nominator Electronic Signature:  
*Do you have anything else you would like to share with the Nominating Committee?