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Prospective NMH Trustee Nomination

Information from this form will be reviewed by the Committee on Trustees. A statement of recommendation must be written and  uploaded in order to complete and submit this form.


Your namerequired
Name of candidate for considerationrequired
Candidate's genderrequired
Candidate's agerequired
Candidate's race/ethnicityrequired
Candidate's constituency (select all that apply)required
Candidate's city and state of residencerequired
Candidate's profession (select all that apply)required
Candidate's area(s) of expertise (select all that apply)required
Candidate's additional characteristics (select all that apply)required
Additional information/considerations (including other board affiliations, interests, hobbies)