Nomination Form 2015 - Yale School of Medicine

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ASSOCIATION OF YALE ALUMNI OF PUBLIC HEALTH (AYAPH)
BOARD OF DIRECTORS
2015 Nomination Form
I wish to recommend _____ myself / _____ a fellow alumnus for consideration as a candidate for the
2015 AYAPH Board of Directors election
Important note: Self-nominations are strongly encouraged.
I. Nominee
Name (please print)
Graduation Year
YSPH Concentration/Major
Address
City/State/Zip
Business telephone
Current Title
Home telephone
Fax number
E-mail address
Current Employer
I. What particular strengths, interests and/or abilities do you feel you (or the nominee you are
recommending) would bring to the AYAPH Board of Directors?
II. What drives your desire (or your nominees’) to serve on the AYAPH Board of Directors?
III. Please provide a brief bio to help the Board better understand your professional background.
If you are recommending an alumnus other than yourself, please fill out the information below:
Your Name (please print)
Graduation Year
YSPH Concentration/Major
Address
City/State/Zip
Business telephone
Home telephone
Please email the form to [email protected]
SUBMISSION DEADLINE: Tuesday August 4, 2015
Fax number
E-mail address
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