Advisory Board Self-Nomination Form

Name:

Street Address:

City/State:

Telephone:  (Work)                                             (Home)

E-mail:

Education:

Present Employment:

Job Title:

Please tell us about your experience and interests that lead you to want to serve on the Social Work Advisory Board.

Have you served or are you currently serving on other boards?  What are/were your primary responsibilities?

Social Work Advisory Board Nomination

What strengths would you bring to the Board?

Are you willing to attend the Advisory Board meetings held two (2) times per year?  Meetings are usually on a Friday morning from 9:00 to 12:00.

Signature:                                                           Date:

Dr. Darlene Lynch

Department of Social Work

Ball State University

AR 227

Muncie, IN 47306-0525