NEOUCOM

Northeastern Ohio Universities Colleges of Medicine and Pharmacy
Annual Call for Nominations
NEOUCOM Committee Openings



NOMINEE INFORMATION


Nominee First Name:

Nominee Last Name:

Committee Name and CC Number:



YOUR INFORMATION

Self Nomination


If Self Nomination, please attach a CV
(Microsoft Word or PDF file; less than 500KB):


Relationship to Nominee:

Your First Name:

Your Last Name:

Your Email:

Your Office Phone:


Brief statement (2-3 sentences) of nominee's
qualifications for this committee:

I acknowledge that this Nominee is
willing to serve, if selected.

NOTE: Red fields are required.