Academy Nominating Committee Application

APPLICATION DEADLINE: SEPTEMBER 15, 2024

Thank you for your interest in applying for service on the 2025 Academy Nominating Committee. All applications will be reviewed by committee representatives and recommended candidates put forward to the Academy Board of Trustees for approval. Applicants will be contacted in November and provided an update on the status of their application.

PURPOSE: The purpose of the Nominating Committee is to identify and recommend qualified candidates to address the current needs of the Academy Board of Trustees, thoroughly reviewing and scoring candidate applications and submitting a recommended slate of candidates for Board approval. Learn more at https://acrpnet.org/about-old/the-academy/academy-committees/academy-nominating-committee/.

Questions? Email Steven Gonzalez, Associate Director of Certification at steven.gonzalez@acrpnet.org.

Candidate Information

Name*

First Middle Initial (optional) Last Suffix/Certifications

Email*

Enter Email Confirm Email

Preferred Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company/Organization*

Job Title*

Are you at least 21 years of age?*

Yes
No

Have you ever served on the ACRP or Academy Board of Trustees?*

Yes
No

If yes, when?

How many years of experience do you have in clinical research?*

Less than one year
1-4 years
5-10 years
11-15 years
16-20 years
More than 20 years

Which of the ACRP credentials do you possess? Check all that apply.*

ACRP-CP
ACRP-PM
CCRA
ACRP-MDP
CCRC
CPI
FACRP (Fellow)
None of these

Which setting listed best describes your current work situation?*

If Other, please specify.

What skills will you contribute to fulfill the Academy Nominating Committee's responsibilities?*

Please upload your Resume/CV (PDF files are preferred).*

Max. file size: 50 MB.

Disclaimer and Consent

I certify that my answers are true and complete to the best of my knowledge. If this application leads to my selection as a committee member, I understand that false or misleading information in my application or interview may result in my release.*

I agree
I do not agree