1.Name (First and Last)

2.City and State of Residence

3.Current or Past Occupation

4.What is your relationship to PANDAS/PANS/AE? 

I'm a parent/caregiver

I'm an educator with knowledge about PANDAS/PANS

I'm a clinician with knowledge about PANDAS/PANS

I'm a professional with knowledge about PANDAS/PANS

I have had PANDAS/PANS

I'm a community member with knowledge about PANDAS/PANS

5.Why are you interested in being on the Board of Directors for Northwest PANDAS/PANS Network?

6.What skillsets would you bring to the organization that could help us fulfill our mission?

7.In your own words, why do you feel it is important to have a local/regional non-profit for PANDAS/PANS/AE?

8.We expect board members to attend monthly board meetings that last an hour. Would you be able to commit to attending the majority of these meetings?

Yes

No

9.Which of these areas would you have interest in supporting?

Legislation

Grant pursuit 

Education (Presentations)

Media support (website, flyer creation, social media, etc)

Translation services

Family support (connecting with new families)

Outreach (finding new avenues for NWPPN to connect with)

Bookkeeping

10.Does NWPPN have permission to publish a photo and bio of you to their website and social media if chosen to join the BOD?

Yes

No