CGMA | Board Self-Nomination Form

Coast Guard
Mutual Assistance

Board of Directors Self-Nomination Form

Purpose: To apply for election to the Coast Guard Mutual Assistance Board of Directors

Please complete all fields.

First Name *

Middle Initial

Last Name *

Suffix

Rank/Rate/Grade/Title*

Home Address *

Address Line 2

City *

State *

Zip Code *

Personal Email *

Personal Phone Number *

Work Email

Work Phone Number

Board Position Applying For*

Year Started Coast Guard (Enlisted/Commissioned/Hired)

Employment History/Experience Please list the most current first.

Title

Organization/Company

Start Date

End Date

What aspect of CGMA's mission holds the greatest personal significance for you?(500 character maximum)

What skills, connections, resources, and expertise are you prepared to contribute as a member of the Board of Directors for CGMA? (500 character maximum)

What attributes are essential for someone to be considered an excellent board member? (350 character maximum)

Do you have any additional information you'd like to share with the selection committee?(350 character maximum)

Thank you for submitting your self-nomination form to Coast Guard Mutual Assistance!