Presidential Search Committee Nomination Form

9000 East Chaparral Road
Scottsdale, AZ 85256-2626
480.423.6000

All Nominations must be submitted by 5:00pm on September 21st

NOTE: * denotes a required field

Your Name: *

Your E-Mail Address: *

Nominee's Name: *

Nominee's Phone Number: *

Nominee's Street Address:

Nominee's City:

Nominee's State:

Nominee's ZIP Code:

Nominee's SCC Affiliation: *

Board Approved Employee
Temporary Employee
Current Student
Previous Student
Community Member

Other (please specify)

Nominee's SCC Affiliation (Years): *

Nominee's Activities: *

Nominee's Gender: *

Male
Female

Nominee's Ethnicity: *

White/Caucasian
Black/African-American
Indian/Native American
Hispanic/Latino
Asian/Pacific Islander
Multiracial

Nominee's Employee Group Affiliation: *

Residential Faculty
Adjunct Faculty
MAT
PSA
Crafts
M & O
Safety
Specially Funded
No Appliciable Employee Group

Nominee's SCC and/or MCCCD Organizational Affiliations:
(select all that apply)

Yes

Women's Leadership Group (WLG)

Yes

United Tribal Employees Council (UTEC)

Yes

Gay, Lesbian, & Human Rights Association (GLHRA)

Yes

Asian Pacific Islanders Association (APIA)

Yes

Maricopa Council on Black American Affairs (MCBAA)

Yes

Arizona Association of Chicanos in Higher Education/Maricopa Association of Chicanos in Higher Education (AACHE/MACHE)

Other (please specify)

Additional SCC/MCCCD/Community Organizational Memberships:

Reason Why Nominee Should Be On The Committee: *

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