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The PBMTC Programs’ Board is composed of three types of Directors – please select the ONE category that best describes this nominee:

Qualifications:

Please provide the following information regarding the Nominee:

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Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png html pdf doc docx ppt pptx.
Attestation:

 

I attest that the information contained on this form has been completed in good faith and is true and complete.  I understand that the PBMTC Program may require additional information and I agree to supply this information if/ when requested.  I authorize the Program to contact any organization or person it deems necessary to verify the information I have provided.  All materials supplied to the Program, become property of the Program once submitted and will not be returned.

If you have questions regarding the nomination process, please contact a representative of the PBMTC Program at heretohelp@distancelearningnetwork.com