BAA Committee Application

1. General Information

This form is for applying to participate on a BAA working committee. This is NOT a confirmation of participation. The committees are working committees (not a conference or workshop) that have specific tasks that need to be completed. We have a limited budget for the number of committee members, so there is an application and selection process. Please fill out the application below if you are interested in being considered for participation on one of these committees. An asterisk means a response to that question is required.

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* 1. First Name:

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* 2. Last Name

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* 3. Role/Title:

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* 4. Primary Phone Number:

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* 5. Secondary Phone Number:

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* 6. Primary Email address:

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* 7. Secondary Email address:

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* 8. Mailing Address

Address

City

State

Zip

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* 9. What geograpic area best describes where you live:

UP/Northern Michigan

Southeast Michigan

Southwest Michigan

Mid-Michigan

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* 10. Highest Level of Education:

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* 11. Major Field of Studies:

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* 12. Applicant's Ethnicity: (needed for NCLB documentation)

American Indian or Alaskan Native

Asian or Pacific Islander

Black, not of Hispanic origin

Hispanic

White, not of Hispanic origin

Multiracial

No Response

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* 13. Applicant's Gender: (needed for NCLB documentation)

Male

Female