Nomination Form - New IEPA Vice President Roles

  • Please complete the following details by 15th September, 2021
    This form must be completed and signed by two nominators as well as the candidate. The candidate must be primarily resident and have their main employment in the region covered by the Vice Presidency for which the candidate seeks election.
    The IEPA board recognises that early intervention in mental health networks are less developed in some of these regions. Therefore, if you wish to stand for election in your region, but you do not know two nominators, existing IEPA board members can fulfil this function.
    Please contact the IEPA office secretariat@iepa.org.au if you require this kind of support to nominate.
  • Please provide your IEPA membership number. If you can't remember your number you can look up you membership number here: https://bit.ly/3iEg7mD
  • Please indicate the position you wish to be nominated
  • Please provide a 250 word biography that we can display on our promotional materials for the election
  • Please provide a Candidate Statement explaining why you would like to be part of the IEPA Board
  • Please provide a high quality headshot in .jpg file format that we can use for the elections
    Drop files here or
    Accepted file types: jpg.
  • Please provide your signature in .jpg or .png file format
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    Accepted file types: jpg, png.
  • Please provide the IEPA membership number for each Nominator. If not known you can share this link with your nominator to help locate it: https://bit.ly/3iEg7mD
  • Please provide signature for Nominator 1 in .jpg or .png file format
    Drop files here or
    Accepted file types: jpg, png.
  • Please provide the IEPA membership number for each Nominator. If not known you can share this link with your nominator to help locate it: https://bit.ly/3iEg7mD
  • Please provide signature for Nominator 2 in .jpg or .png file format
    Drop files here or
    Accepted file types: jpg, png.
  • This field is for validation purposes and should be left unchanged.