2018 AAPA Board Leadership Program Application
Thank you so much for your interest in applying to the AAPA Board Leadership Program. Please complete the application questions below. If you have any questions at all, feel free to email us anytime at info@aapamentoring.com
Within a few weeks after receipt of your application, we will update you on the status of your application. Payment will be due at the time you are accepted to the program.

Annual program fee: $500 (receive 10% off if you apply on/before December 31, 2017)

Application deadline: January 31, 2018

Program Dates:
• Saturday, April 2018: Session #1
• Saturday, May 2018: Session #2
• TBD, July 2018: Executive Panel
• Saturday, August 2018: Session #3
• Saturday, September 2018: Session #4
• Thursday, December 2018: AAPA Graduation Gala

For program info: http://aapamentoring.com/blp/

First Name *
Your answer
Middle Initial
Your answer
Last Name *
Your answer
Email *
Your answer
I. PERSONAL INFORMATION
Sections I-III can also be answered by providing your most recent resume to info@aapamentoring.com
Phone #
Your answer
Address (street, city, state, zip)
Your answer
Ethnic origin/race (optional)
II. EMPLOYMENT/VOLUNTEER EXPERIENCE
Sections I-III can also be answered by providing your most recent resume to info@aapamentoring.com
Employer/Business #1
Your answer
Title
Your answer
No. of years
Your answer
Address (street, city, state, zip)
Your answer
Phone #
Your answer
Brief description of your position
Your answer
Employer/Business #2
Your answer
Title
Your answer
No. of years
Your answer
Address (street, city, state, zip)
Your answer
Phone #
Your answer
Brief description of your position
Your answer
Employer/Business #3
Your answer
Title
Your answer
No. of years
Your answer
Address (street, city, state, zip)
Your answer
Phone #
Your answer
Brief description of your position
Your answer
III. EDUCATION & CERTIFICATIONS
Sections I-III can also be answered by providing your most recent resume to info@aapamentoring.com
Institution
Your answer
Degree/Certificate
Your answer
Institution
Your answer
Degree/Certificate
Your answer
IV. SKILLS & EXPERTISE
AAPA Mentorship Program Graduate? *
If "yes," which track(s) did you complete?
Your skills and expertise (check all that apply) *
Required
V. NONPROFIT AREAS OF INTEREST
Your nonprofit areas of interest (check all that apply) *
Required
VI. AREAS OF BOARD INTEREST
Areas of board interest (check all that apply) *
Required
VII. AVAILABILITY
How soon would you be able to serve on a board? *
Your answer
For how long would you be able to serve on a board? *
Your answer
VIII. STATEMENT OF INTEREST
Please submit your "Statement of Interest" in a separate Word document to info@aapamentoring.com. Please limit your statement to less than 1,000 words.
IX. STATEMENT OF AGREEMENT
I wish to participate in the AAPA Board Leadership Program. I certify that all the information in this application is
true and correct to the best of my knowledge. I understand that acceptance into the program will require me to
meet the following minimum criteria:
• Attend at least 75% of the sessions of the Board Leadership Program.
• Upon completion of the workshops, I will be open to serving on a nonprofit board for at least one full
term.
Full Name (this is your digital signature) *
Your answer
Date *
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Comments? Questions? Please let us know here. Or email us at info@aapamentoring.com
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