Second Vice President Nomination Form

The Second Vice President is an officer on the Board of Directors and a member of the Affiliate Council of the National Environmental Health Association. This national officer moves in succession from Second Vice President to First Vice President to President- elect to President to Immediate Past President.

In order to be considered complete, any nomination must:

  • Upload with the online submission form, a completed member signature form with five signatures of voting NEHA members, in which three of the five members represent different affiliates
  • Upload with the online submission form, a high resolution (300 dpi) headshot with a solid background
  • Be submitted online by Dec1st in the year prior that he or she is being considered for nomination

Candidate Information


Business Address


Home Address

Candidate Bio-sketch

Please provide a 800-word (maximum) Bio-sketch of the Candidate that will be included as part of the ballot

Note: This may include career highlights, the candidate’s thoughts on the profession or environmental health in general, etc. If the bio-sketch exceeds 800 words, the Nominations Committee will end the sketch at the sentence before the maximum is exceeded.

 

Employment History

Please include date range, employer, and job title:

Please include full employment history on resume.

Education and Credentials

Educational History

Additional Relevant Continuing Education

Credentials

Publications and Awards

Publications

Awards and Recognitions

Other Affiliations and Professional Memberships

NEHA/Affiliate Offices and Chairmanships

 

Professional Memberships

Community Activities / Committees

Upload Resume

Files must be less than 2 MB.
Allowed file types: pdf doc docx.

Upload Headshot

Note: headshot must be high resolution (300 dpi) headshot with a solid background

Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png.

Upload Member Signature Form

Membership Signature Form (PDF)

Note: For a signature to be valid, a member must be an active NEHA voting member on the date of his or her signature. Invalid signatures may affect the candidate’s nomination.

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

Upload Additional Information

Please upload Additional Information that might be helpful to the nomination committee

Files must be less than 2 MB.
Allowed file types: pdf doc docx.

Signature

I hereby certify that, to the best of my knowledge, no aspect of my current personal or professional circumstances places me in the position of having private interest, which is in conflict with any interest of NEHA or with my obligations to NEHA, except as disclosed here: