AAP FamilY Partnerships Network – Executive Committee CALL FOR NOMINATIONS The Executive Committee of the FamilY Partnerships Network (FPN), an advisory group to the American Academy of Pediatrics (AAP) Board of Directors, is being expanded from 4 to 7 members. The FPN itself is transitioning to a broader role to fulfill the Board resolution to “develop and implement a strategy to expand the opportunity for parent/family/youth input and participation in AAP activities and programs.” Expectations are that the FPN Executive Committee will include: members who represent a diversity of interests and experiences fathers, mothers, youth, guardians or other family members members who are actively engaged in children’s health care members who have both special or specific interests as well as broad, general interests in the health and health care of children and families members whose experience is at local community; and/or state; and/or national levels members connected to parent/family/youth networks members who believe collaboration with pediatricians and other professionals is essential to quality child health Members will be expected to: attend two in-person national meetings per year (expenses paid) participate on monthly conference calls mentor other family/youth to participate in AAP activities review and comment on proposed AAP policies and documents actively participate in the work of the AAP, express family/youth viewpoints and issues, identify resources and links to further family/youth resources further the work of the FPN as goals and activities are developed To Apply If you would like to be considered for membership on the FPN Executive Committee please: 1. complete the application form below 2. write a few sentences regarding your interest and experience Application materials should be submitted by January 5, 2015. Submissions and any questions about this Call for Nominations should be sent to: Sunnah Kim, AAP Staff firstname.lastname@example.org Phone: 847-434-4729 Fax: 847-228-8651 AAP FamilY Partnerships Network APPLICATION Name: Street Address: City, State, Zip: Email Address: Phone Number: 1. Which best describes you? Check all that apply. Youth/Young Adult – “Typically Developing” Youth/Young Adult with Special Health Care Needs Mother of Typically Developing Child(ren) Father of Typically Developing Child(ren) Mother of Child with Special Health Care Needs Father of Child with Special Health Care Needs Sibling of Child with Special Health Care Needs Grandparent Guardian Other (Please Describe): 2. Are you employed as a youth/parent/family member in an area of child health or family resource and support? Yes No If Yes, please indicate position and organization: 3. Are you or have you in the last 5 years been a participant or member of an AAP Initiative, Advisory Group, Committee/Section/Council/Task Force/Special Interest Group or other? Yes No If Yes, please provide some additional information below: Initiative/Group Name: Role (eg., liaison, advisory, speaker, reviewing/developing material): Approximates dates of involvement: 4. Are you active in other local, state, or national pediatric activities? Yes No If Yes, please check all that apply: With a local pediatric practice With a children’s hospital With your AAP State Chapter With your state Title V Program (State Health Department) With a family or youth support organization or network Other (Please specify): 5. What are your special interests and skills? Check all that apply: Interests Family-to-family or peer support/youth support Child health financing Child health policy Child health and wellness Education of families/youth or professionals Emergency preparedness Legislative advocacy Medical ethics Medical home Mental health Palliative Care/Hospice Patient safety Technology Transition from pediatric to adult care Specific condition or disability (please note below) Special population groups (e.g., special health care needs, Hispanic, Black, urban, rural, adolescent please note below in the Comments section.) Comments: Skills 6. Please provide the name of a pediatrician who can serve as a reference, along with contact information. (Your child’s personal pediatrician or a pediatrician you have worked with.) Please let them know you are applying and that they may be contacted regarding this application. Pediatrician Name: Email Address: Phone Number: 7. Please provide a few sentences regarding your interest and experience and the unique perspective you will bring to the FPN Executive Committee.