Advocacy Committee Chair Application

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* 1. Please provide the following contact information:

Name (first, last):

Institution/Practice:

Title:

Email Address:

AAP ID#:

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* 2. Please list current/past roles in the AAP (local, district or national) and describe any current/past leadership activities outside of AAP.

How do you plan to balance your current commitments with this new responsibility?

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* 3. Please describe your interest in becoming an Advocacy Committee Co-Chair including any specific contributions you would like to make to the Chapter and any specific topical interests (300 word limit).

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* 4. Please describe experiences that you have with fostering diversity, equity and inclusion in a professional setting.

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* 5. Narrative biosketch: Please provide a brief biography here

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* 6. Upload your CV here.

Please email CV to info@aapca1.org if you encounter any difficulty with uploading here.

PDF, DOC, DOCX file types only.