Board of Directors Nomination Application SUSF Board of Directors Application Applicant InformationApplicant Name(Required) First Last Applicant Email(Required) Applicant Phone(Required)Applicant Gender Female Male Transgender Non-binary Applicant Race/Ethnicity White Black or African American Hispanic or Latino Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Two or more races Other Applicant Institution(Required) Department General Area of Surgery Is applicant a current SUS member?(Required) Yes No Unsure Is applicant open to a 4 year term (instead of a 3 year term)?(Required) Yes No Unsure Name of Nominator (if not the applicant) First Last Email of Nominator (if not applicant) ApplicationQualifications(Required)Short letter (approximately 1 page or <250 words) detailing the nominee’s qualifications for this position and involvement with the SUS.Max. file size: 512 MB.CV(Required)Current CV for the nominee.Accepted file types: pdf, png, jpg, doc, docx, Max. file size: 512 MB.If you have any questions or require additional information regarding the application, please contact Sara Rossi Statis, SUSF Executive Director, at sara@susweb.org
