NENA Board of Directors Nomination Form

NENA Board of Directors Nomination form for 2015

1.  Before completing this nomination form, please read the documents listed below and available at

a.  “Letter to Board Candidates” dated July 13, 2015 which, among other things, explains the expectations of Board membership; and

b.  The document created by the Oregon Attorney General’s Office regarding expectations of Board members for non-profit organizations - “Guide to Non-Profit Service.”

2.  After filling in the information, save the file and add your initials to the file name, then email to Gina Haupt, Nominating Committee Chair at .

3.  All nomination forms must be received by midnight on July 31, 2015.

To learn more about NENA and what we do, please contact one or more of the Board officers listed at the end of the pre-nomination “Letter to Board Candidates” or visit our website,

Nomination Form

Simply tab through the form to insert your answers

Name, phone number, and email address of person making the nomination:


Phone #:


Name and contact information of nominee (you may nominate yourself or another person; please confirm here, if applicable, that the person being nominated has agreed to serve, if elected. ):


Phone #:


Name of nominee’s Employment Network (EN) or State Vocational Rehabilitation (VR) organization:

Nominee’s email address:

Nominee’s website address:

State(s) where nominee’s EN provides services:

Nominee’s job title:

Qualifications and experience of nominee (120 words max):

Areas where nominee can help NENA and the Ticket Program: