Board of Directors Application CPA is committed to establishing a Board of Directors that is reflective of the diverse communities we serve throughout the state of Pennsylvania. As an equal opportunity organization committed to Diversity, Equity, Inclusion, and Belonging (DEIB), we will proudly consider all qualified applicants. More details about Director positions can be found here. Contact Information Name * Name First First Last Last Organization/Coalition * Job Title * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal County * Email Address * Prevention History How long have you worked in the field of Prevention? * Less than 1 year 1-2 years 3-5 years 6-10 years 11-15 years 16-20 years 20+ years I do not work in the prevention field Are you currently serving on the CPA Board of Directors? * Yes No Current Board Members Contributions * As a current member of the CPA board of directors, please share how your contributions over the past year (or 2 years) have supported or advanced the CPA mission, vision, and core values. Include your participation on a CPA committee, campaign, or initiative involvement/implementation (Prevention Week, Conference, PaStart, or PaStop). 0 of 250 max words Connections * What are some valuable connections you have inside or outside the field of prevention that can help advance the work of CPA? 0 of 175 max words Time Committment * Outside of the standing board meetings (approximately 2 hours each), how much time are you able to commit to CPA on a monthly basis? New Board Members Mission, Vision, Values * What part of CPA's mission, vision, or core value resonates with you and why? CPA's mission, vision, and core values can be found here. 0 of 175 max words Diversity, Equity, Inclusion, and Belonging * Please share how you will help CPA advance our Diversity, Equity, Inclusion, and Belonging priorities. CPA's mission, vision, and core values can be found here. 0 of 175 max words Personal Goals * What are your personal goals for serving on the board? 0 of 175 max words Connections * What are some valuable connections you have inside or outside the field of prevention that can help advance the work of CPA? 0 of 175 max words Time Committment * Outside of the standing board meetings (approximately 2 hours each), how much time are you able to commit to CPA on a monthly basis? Committees, Initiatives, Campaigns * Have you served on a CPA committee or participated in one of the following CPA initiatives or campaigns in the past two years? Advocacy Committee Conference Committee Diversity, Equity, Inclusion, and Belonging (DEIB) Committee Finance Committee Membership Committee Social Media Committee I attended or participated in the Prevention Week Awards I attended the CPA Conference We have used PaStop and/or PaStart Materials None of the Above Other (please specify)Other (please specify) Acknowledgements & Agreements Please check all that apply. * I will ensure that my CPA membership is current which is required if selected to serve on the CPA board. I am willing to serve a 2-year term, if elected, from 1/1/2025 - 12/31/2026. I am willing to fill the remaining term, if elected, associated with a vacant seat, through 12/31/2025. By submitting this application, I agree to the following: I am submitting my name for consideration as a CPA Board of Directors. I am doing so with the knowledge that if elected, I will serve a 2-year term, from January 2025 – December 2026, unless I am asked to fill a vacated board seat (then the term will end on 12/31/2025). For the benefit of the organization and to enhance my contributions to CPA, I agree to attend (in person or virtually) the board of director meetings, support the conference committee, and actively serve on at least one committee. I acknowledge that I have reviewed and accept the responsibilities expected of a CPA Board member, as described on our website (please go HERE to review). If applicable, my supervisor or board president is aware of my application submission and, if elected, supports my participation and time on the CPA board of directors. My application may be shared with CPA membership for voting purposes. Confirmation * I have read and accepted the acknowledgment section above, including a review of the director's responsibilities. Yes Submit Your Application If you are human, leave this field blank.
