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NWACUHO Elections Nomination Form
Name of the Person Nominated *
Your answer
Nominee's Institution *
Your answer
Nominee's Current Title/Role *
Your answer
Nominee Email Address *
Your answer
Nominee Preferred Phone Number *
Your answer
Please select which board position you'd like to nominate the nominee: *
Please submit the link to your 1-minute video (if you are unable to upload the video, please contact past-pres@nwacuho.org
Your answer
Nominator Information
Not required for self-nominations
Your Name
Your answer
Your Institution
Your answer
Your Title/Role
Your answer
Your Email Address
Your answer
Your Preferred Phone Number *
Your answer
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