National Earth Science Teachers Association
Candidate Nomination Form
All nominees must be members in good standing at time of nomination.
Terms run from May 1, 2015 – April 30, 2017.
Part A: Contact Information:
Name:
Home Street Address:
Home City/State/Zip Address:
Home Phone:
Home e-mail:
WorkStreet Address:
Work City/State/Zip Address:
Work Phone:
Work e-mail:
Part B:OpenPositions:Please select the position you desire to run for from the list below:
___ President-Elect
___ Treasurer
___ Secretary
___ East Central:Indiana, Kentucky, Michigan, and Ohio
___ Eastern:Delaware, New Jersey, and Pennsylvania
___ Mid-Atlantic:Maryland, Virginia, Washington DC and West Virginia
___ New England:Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont
___ Northwestern:Alaska, Idaho, Oregon, and Washington
___ Southeastern:Alabama, Florida, Georgia, Mississippi, North Carolina, Puerto Rico, South Carolina, and Tennessee
___ If elected as a Regional Director (or I will still be a Regional Director on May 1, 2015), I would like torun for the Board Representative to the Executive Committee for the 2015 – 2016 term.
___ I currently hold an Appointed Office in NESTA that has a term that continues until April 30, 2016and would like to run for Board Representative to the Executive Committeefor the 2015 – 2016 term.
Part C:Candidate Background Information Statement:(Education, professional service, awards, etc)
A strict word limit of 250 words will be enforced.
Insert here:
Part D: Candidate Position Statement: A strict word limit of 250 words will be enforced.
Insert here:
Part E:Photo:Please send a recent photo as a separate attachment.
Part F:Candidate’s signature:
Name:______Date: ______
(Typing your name constitutes your signature, subject to verification later in the candidate search process.)
John D Moore,NESTA
If you would like to discuss your potential candidacy, please send an e-mail with your phone number and the best times to reach you.