Nomination Form
for
2018Midwest District Leadership Council

Qualifications:

1)All candidates must reside or work in one of the Midwest District states, must be a current member of SHAPE America and must maintain their membership throughout their term of office.

  • District president will serve a three-year term (one year as president-elect, one year as president and one year as past president)
  • Members-at-large will serve a two-year term (three members-at-large will be elected in odd years and two will be elected in even years)

2)Candidates for president-elect shall have held continuous membership for three years prior to being placed on the ballot. It is recommended, but not required, that candidates have previously served at least one two-year term on the District Leadership Council, formerly called District Board.

3)Candidates for member-at-large shall have held continuous membership for two years prior to being placed on the ballot. It is recommended that candidates have previously served at the state or district level in leadership positions.

To nominate yourself or another qualified nominee, please provide the following information:

For the Office of: (please check)

___ President-elect ___Member-at-Large

PART A

Name ______Title ______

Business Address ______

StreetCityStateZip Code

Home: Address: ______Street City State Zip Code

Work Phone ______Home Phone ______

Cell Phone ______Email Address______

SHAPE America Membership #______Exp Date______# of Years as Member ______

PART B

Consent Form

I consent to have my name placed in nomination for the office of ______in SHAPE AmericaMidwest District.

______

Print Name Signature Date

PART C

SignaturesoftwocurrentMidwest Districtmemberswhosupportyournomination:

1.______

Print Name Signature SHAPE America Membership #

2.______

Print Name Signature SHAPE America Membership #

Return the completed Nomination Form to:

Kim Eiler

Midwest District Nominations Chair

DEADLINE: September 15, 2017

Finalcandidatesforelectionwillbeselected by the MW Nominations Committee and askedtoprovidethefollowing via email:

a.Abbreviatedprofessionalvita(maximum twopages; submitted inMSWord format)

b.Photo(color headshot,submittedas.jpegattachment with candidate’s name as file name)

c.“VisionStatement”forMidwestDistrictasitpertainstotheofficeforwhichyouareacandidate(Nomorethanonedouble-spacedpageor150words,whicheverisless;MSWord format)

d.Allthreeitemsabovemustbesubmitted by November 1, 2017 to Deb Berkey,MidwestDistrictExecutiveDirector, at .

NewlyelectedofficersassumetheirpositionsatthecompletionoftheSHAPEAmerica National Convention (held in Nashville, March 20-24, 2018).