ABOUT US > Advisory Council > Nomination Form
 
Nominee's Name:
Address:
Phone (w):
Phone (h):
Fax:
Email:
Title:
Organization:
Areas of expertise:
1. Describe experience in anti-sexual violence work and/or any other relevant experience:
2. Describe experience in board work, team work, negotiation and hands-on collaboration:
3. Describe expertise in working with people of different social, ethnic and gender backgrounds or any other experience or work that would reflect a commitment to cultural competency:
4. List any noteworthy contributions to the anti-sexual violence movement:
5. List three qualities/expertise that would indicate an essential match to enhance the activities of the NSVRC:

6. List three references with address, phone number and affiliation:

*If this is a nomination, we ask that you obtain permission from the nominee.

Name and contact information of person making the nomination:
Name:
Address:
Phone (w):
Phone (h):
Fax:
Email:
Title:
Organization:
Additional Comments:

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