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EUREKA Board Nomination

EUREKA/eCOCIS is now requesting nominations for the EUREKA Board. Anyone from a licensed EUREKA or eCOCIS site can be a member of the EUREKA Board of Directors. 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, please fill out this form and return to us by November 30, 2006. You may also nominate yourself.

After filling in the form, click the Send It 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 nominees accomplishments below: