2022 HOD SUPER-DELEGATE APPLICATION

Thank you for your interest in serving as a House of Delegates' (HOD) Super-delegate for the Southeast Region of the United States. The Southeast Region includes Alabama, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee.

We are looking for a dynamic spokesperson for the allergy specialty. Diversity and experience in government, politics and advocacy groups is what makes our organization great. Super-delegates are responsible for bringing legislative, professional and business issues and concerns of the allergy communities to the College.

Below are questions and information that help the College leaders understand who you are and what experiences you have or could bring to representing our members in the political arena. Serving as a super-delegate is an important way to support our members and ensure the allergy specialty continues.

Please keep the following in mind:
* You must be an active College Fellow to apply.
* Super-delegates serve five-year renewable terms.
* Candidates must live or work within the specified region.

Super-delegates serve as the conduit between local, state and regional allergy societies and the HOD leadership. They facilitate the communication of important issues and concerns amongst these key stakeholders. Super-delegates should also build rapport with legislators, lobbyists, allergists, and member societies in his or her region. Super-delegates will monitor local legislation; establish contacts with local and state legislators, allergists and regional allergy societies. They will share advocacy information with HOD leaders, state delegates and Advocacy Council leaders.

More information is available about the super-delegate position - https://college.acaai.org/college-super-delegate-job-description/.

Please complete the following application form. Applications are being accepted Jan. 15 – Feb. 28, 2022. All submitted applications will be vetted by the HOD’s Nominating Committee; one super-delegate for the Southeast Region will be chosen for a five-year term. The chosen applicant will be notified by June 1.

The HOD's Southeast Region includes: Alabama, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee.

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* 1. Please provide your name and contact information.

Last Name

First Name, Middle

Email Address

Cell Phone Number

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* 2. Where do you practice? (If you have more than one office, list your main office.)

City/Town

State/Province

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* 3. How many years have you practiced in this state?

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* 4. Are you Board Certified in allergy?

Yes

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* 5. Are you a practicing allergist?

Yes

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* 6. What issue(s) are you passionate about?

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* 7. Are you a member/affiliate of: (list organization name)

Political organization(s)

Community organization(s)

State medical society

Lobbyist

Local allergy society

Regional allergy society

State allergy society

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* 8. Have you held leadership positions with any of the above organizations/societies?

Yes

If you answered yes, please list positions held (current/previous).

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* 9. List your relationships with: (name/relationship)

State legislators

Federal legislators

Lobbyists

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* 10. Describe your prior advocacy-related work; include grassroots advocacy:

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* 11. List relevant accomplishments:

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* 12. Why do you want to be a super-delegate?

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* 13. Please upload a copy of your CV.

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