If we are unable to slate you for the above position(s) would you be willing: YES NO be slated for any other position? …to YES NO be appointed to any position? …to 1 2 Nomination Information 3 Self Chapter Staff NASW Member Other Application Submitted by: If not self, indicate name: Have you ever or do you have pending proceedings for unethical Yes No practice? Have you ever or do you have pending licensure or certificate Yes No disciplinary proceedings? Leadership: NASW is looking for leaders who support the mission and goals of the Association, and who will support its growth and development on behalf of the membership and groups served by the profession. What leadership, collaborative skills, and experience do you bring to this effort? Social Work Practice Expertise: Please list your practice focus (Aging, Child Welfare, Health, etc.).
1 2 3 If we are unable to slate you for the above position(s) would you be willing: …to be slated for any other position? YES NO …to be appointed to any position? YES NO Nomination Information Self Chapter Staff NASW Member Other Application Submitted by: If not self, indicate name: Have you ever or do you have pending proceedings for unethical practice? Yes No Have you ever or do you have pending licensure or certificate disciplinary proceedings? Yes No Leadership: NASW is looking for leaders who support the mission and goals of the Association, and who will support its growth and development on behalf of the membership and groups served by the profession. What leadership, collaborative skills, and experience do you bring to this effort? Social Work Practice Expertise: Please list your practice focus (Aging, Child Welfare, Health, etc.).