2021 AST Board Nomination Submission Form

Note: Required fields *

 
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Enter your name, or the name of the person filing this nomination. If you are nominating yourself, enter "self."
Enter the first and last name of the potential candidate. If you are nominating yourself, enter your first and last name.

AST has implemented guiding principles for service on the AST Board of Directors to avoid conflicts of interest. Nominees will be asked to disclose all financial and administrative relationships for review by the conflict of interest committee following submission of their nomination. The Governance Committee will also review nominations for the following conflicts of interest:

The Governance Committee will determine, on a case-by-case basis, the eligibility of nominees who currently serve in a non-officer position on a professional medical society governing body. 

(Please attach CV)
Files must be less than 100 MB.
Allowed file types: pdf doc docx.
Please provide your vision for the future of the AST and also describe your leadership abilities by addressing the 7 leadership criteria listed in the call for nominations. Minimum of 500 words.
Please list your service in a leadership position on AST committees, communities of practice, advisory councils, task groups, or other service.
Please list the AST or ATC meetings attended over the past five years.
(Financial, Organizational, Governance, Technology, etc.)

Please upload your reference letters below.

(Please attach)
Files must be less than 100 MB.
Allowed file types: pdf doc docx.
(Please attach)
Files must be less than 100 MB.
Allowed file types: pdf doc docx.