APCA Advisory Committee
Application & Committee Selection Form
To apply for the APCA National and/or Regional Advisory Committee positions, please complete the following application and submit.

Today Is:   Name: School: Address: Telephone:   Fax: Title: Email: EDUCATIONAL INFORMATION Dates Attended: College / University: Major: Degree: Other colleges attended: WORK RELATED EXPERIENCE Dates: Business/School: Position: Responsibilities:     Dates: Business/School: Position: Responsibilities:     Dates: Business/School: Position: Responsibilities: More Work Related Experience: Past APCA Positions/Activities/Programs/Honors/Sessions Dates: Position / Activities/ Program / Honors/ Sessions:     Dates: Position / Activities/ Program / Honors/ Sessions:     Dates: Position / Activities/ Program / Honors/ Sessions: Related Organization Experience Dates: Organization: Position: Responsibilities: More Organization Experience: Please answer the following questions: 1.) What work experiences, education, personal skills and characteristics ( e.g., planning, recruiting, program development, meeting facilitation, organizing, etc.) will you contribute to the position and/or committee? 2.) Will your organization or institution support you (financially, time off, delegate fees, travel, etc) in your attendance of APCA required events? Do you foresee any problems other than financial support or time off that would prevent you from attending required regional or national events? 3.) Please provide a brief description of the personal and professional development goals that you would like to accomplish by holding a position on the committee. Regional Advisory Committee: (SELECT ONE)   Regional Coordinator   Associate Member Representative   State Coordinator All applications will need to include the following items: A color photo (head shot) emailed to the APCA Office A letter of financial & time off support from the institution you will represent during your committee position term. A 150 word biography statement as it would appear in APCA publications. Position/Committee Selection Form (YOU CAN BROWSE FOR THE ABOVE LISTED ITEMS, BELOW) 150 word biography statement (as it would appear in APCA publications): Color Headshot Photo: 2MB or less  A letter of financial & time off support from the institution you will represent during your committee position term. 2MB or less  Position Committee Selection Form: 2MB or less  Thank you for taking the time to complete the selection form and applying to serve as a volunteer in a committee position.  The submitting of the application does not automatically place you in a committee position.  We will notify you if you are selected to serve in a committee position.  Please feel free to select any positions that interest you.

APCA Contact Information:  Phone: 1-800-681-5031 •  Fax: (865) 908-7104

Mailing Address: APCA P.O. Box 4340 Sevierville, TN  37864 Shipping Address: APCA 711 Topside Drive Sevierville, TN  37862