Nomination Form

NTCSA Board Nomination Form

"*" indicates required fields

Name of Nominee*

Nominated By*

Nominee Address*

Nominee Phone*

Position Being Nominated for (Check Appropriate Box)*

President

Secretary

Board Member

Nominee Current Employer*

Nominee Child Support Experience

Private Contractor

How many years

Tribal Child Support Agency

How many years

Family Court

How many years

State or Federal Child Support

How many years

Other Child Support Experience

How many years

Briefly describe your other experience

Position titles held

Has Nominee attended the last annual conference and/or paid their dues to be considered an active member*

Yes

No

Nominee NTCSA experience

Conference Workshop Speaker

Conference Workshop Moderator

Conference Vendor

Conference Attendee

NTCSA Board Member

NTCSA Officer Position

If any of the above NTCSA experience boxes are checked, use the space below for details, dates, and comments*

Completed Nomination Forms will be accepted from May 9, 2023 through June 9, 2023.

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