Interested in becoming a leader in FSOSW? – Florida Society of Oncology Social Workers

Name

Preferred Mailing Address

Email

Business Phone

Home Phone

Position of Interest

If "Other", please specify the position

If we are unable to slate you/colleague for the above position, would you/colleague be willing to be appointed to any other position?

Yes

No

If ‘Yes”, please list other positions of interest

Submitted by FSOSW member

Yes

No

Submitted by Self

Yes

No

Professional History

Resume or CV

Maximum file size: 20MB

Highest Social Work Degree

Year Earned

School of Social Work

Social Work Credentials

FSOSW Leadership History

Certain positions require prior FSOSW leadership experience. Please describe you or your colleague’s FSOSW experience.

Other Leadership History

Indicate other leadership experience relevant to the position sought including local, state, or national affiliations.

Position Statement

This information will inform the membership about you and your vision of the contributions you intend to make in your role as an elected FSOSW officer.

Nomination Submitted By

Name

Date

Institution

Email

Phone

Address

City, State and Zip Code

Signature

Florida Society of Oncology Social Workers

FSOSW LEADERSHIP NOMINATION

Nomination Submitted By

ABOUT FSOSW