TAC Nominations

Thank you for submitting a nomination for the APA Minority Fellowship Program's Training Advisory Committee (TAC). Please complete the information below and upload the applicable documents. For detailed instructions, view our: 2017 STAY- TAC call for nominations. For more information, please visit: http://www.apa.org/pi/mfp. If you have any questions, please contact us at mfp@apa.org or (202) 336-6127.

Are you a TAC nominee, or are you providing a recommendation for a TAC nominee? *This question is required.

Nominee's First Name: *This question is required.

Nominee's Last Name: *This question is required.

Nominee's Degree: *This question is required.

Nominee's Contact Information: *This question is required.

Address 1:
Address 2:
Address 3:
City:
State:
Zip:
Phone:
Email:

Nominee's Institution: *This question is required.

Nominee's Position: *This question is required.

Nominee's Sex/Gender:

Nominee's Race/Ethnicity:

Professional Specialties/Interests: *This question is required.

Are you an MFP Fellow (Note: Psychology Summer Institute Fellows are also considered MFP Fellows)?

If appointed to the TAC, you will be required to attend a weekend-long committee meeting in Washington, DC (Thursday night arrival; Sunday afternoon departure). We will welcome our new TAC members and select new Fellows at this meeting.

Are you available to attend the TAC selection meeting in March 2018? *This question is required.

Please provide your reason for not being able to attend the TAC selection meeting: *This question is required.

Recommender's First Name: *This question is required.

Recommender's Last Name: *This question is required.

Recommender's Degree:

Recommender's Institution:

Recommender's Email Address: This will only be used if MFP has questions about your submission.

Recommender's Phone Number: This will only be used if MFP has questions about your submission.

For each of the following questions, please upload the applicable document by clicking the Browse button and selecting the appropriate file from your computer:

Letter of Interest: *This question is required.

File: {{filename}} delete

Curriculum Vita: *This question is required.

File: {{filename}} delete

Letter of Support 1 (if applicable):

File: {{filename}} delete

Letter of Support 2 (if applicable):

File: {{filename}} delete

For the following question, please upload your letter of support by clicking the Browse button and selecting the appropriate file from your computer:

Letter of Support: *This question is required.

File: {{filename}} delete

TAC Nominations - STAY

Page One