Nomination Form
for
Midwest District Leadership Council

Qualifications:

1)All candidates must reside 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)
  • Future professionals will serve a one-year term, with the option of a second year

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:

Dr. Pam Bechtel

Midwest District Nominations Chair

613 Lafayette

Bowling Green, OH 43402

(419) 410-4310

DEADLINE: October 30, 2015

Finalcandidatesforelectionwillbeselected by the MW Nominations Committee during November 2015 and askedtoprovidethefollowing via email:

a.Abbreviatedprofessionalvita(maximum twopages; submitted inMSWord format)

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

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

d.Allthreeitemsabovemustbesubmitted by December 1, 2015 to Jim Cook,MidwestDistrictExecutiveDirector, at .

Candidate information will be posted on the Midwest District website by February 1, 2016. Voting opens on March 4, 2016 and closes on April 7. NewlyelectedofficersassumetheirpositionsatthecompletionoftheSHAPEAmerica National Convention (held in Minneapolis, April 5-9).

Formoreinformation, contact Dr.PamBechtel, Midwest District nominations chairor JimCook,MidwestDistrictExecutiveDirector.