Data & Impact Committee Nomination Form Survey

Alaska Region - members located in the state of Alaska

Pacific Region – members located in the states of California and Hawaii

Southwest Region - members located in the states of Arizona, Nevada, New Mexico and Utah

Northwest Region - members located in the states of Idaho, Oregon and Washington

Southern Plains Region - members located in the states of Kansas, Oklahoma and Texas

Great Plains Region - members located in the states of Iowa, Nebraska, South Dakota and North Dakota

Midwest Region - members located in the states of Minnesota and Wisconsin

Eastern Region - members located in the states of Alabama, Arkansas, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Ohio, Pennsylvania, New Hampshire, New Jersey, New York, North Carolina, Rhode Island, South Carolina, Tennessee, Vermont, Virginia and West Virginia

Rocky Mountain Region - members located in the states of Colorado, Montana and Wyoming

Data & Impact Committee Nomination Form

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* 1. Name

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* 2. Native CDFI

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* 3. NCN Region

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* 4. Why are you interested in serving on the NCN Data & Impact Committee?

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* 5. Please share a brief bio and qualifications for background.

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* 6. Are you able to commit to being an active participant in 4x meetings a year with NCN or other related events?