CANCER EDUCATION AND RESEARCH INSTITUTE (CERI)
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Board of Directors Candidate Application Form

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The form will NOT save your answers. 

If you experience any technical issues, feel free to use the Google Form to submit your application HERE

    CANDIDATE INFORMATION

    PROFESSIONAL BACKGROUND

    EXPERTISE & CONTRIBUTIONS

    COMMITMENT

    BOARD CANDIDATE QUESTIONNAIRE 

    REFERENCES

    Please provide 2 professional references:

    Reference 1:

    Reference 2:

    SIGNATURE

    Max file size: 20MB
    I certify that the information provided is accurate and complete. Successful applicants will complete a Board Member Agreement upon appointment to the position. 
Board Member Application Statement