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EUREKA Board Nomination

EUREKA, CCIS is requesting nominations for the EUREKA Board. A Board Member must be willing to commit to a three (3) year term.

If you know of someone at your site or another EUREKA Site who you would like to see serve on the EUREKA Board, please fill out this form and return to us by January 30, 2009. You may also nominate yourself.

After filling in the form, click the Submit button at the bottom. Or print and fax this form to 510.669.0992.

Nominee:
Position:
Agency/School:
Address:
City, State, and Zip Code:
Ph. Number:
Email:
Supervisor's name:
Nominated by:
Title:
Ph. Number:
Email:
Describe nominee's accomplishments below: