Education Advisory Committee (EAC) Form

Use this form to indicate your interest in serving on YALSA's Education Advisory Committee (EAC) to assist with identifying and providing feedback on Continuing Education topics to YALSA's Executive Director and the newly created Program Officer for Continuing Education and Development position. The chair serves in an Ex-Officio position on the Board of Directors and attends two board meetings. This is a virtual committee with a one year (12 months) term beginning July 1 and is renewable.

Complete this form by the extended deadline, June 10.

Please Note: Completing the form does not automatically place an individual as a member of the EAC.

Personal Data Notification

The ALA (American Library Association and its units) and the ALA-APA (Allied Professional Association) (collectively “ALA”) use the personal data you provide to the ALA to process membership, inform you of products, services, conferences, education opportunities, events and for other purposes which are within the Association’s mission. To accomplish these actions, ALA contracts with third-parties who gather and process personal data to complete interactions such as online purchases, conference registration, and fulfillment. The personal data as provided is processed and stored as a legitimate Interest to the ALA in order to fulfill your requests for information and services from ALA.

For more information, review ALA’S PRIVACY POLICY: http://www.ala.org/privacypolicy

Name of person completing this form: *

Please list your job title and institution: *

Please enter your city and state: *

Preferred telephone number: *

Preferred email address: *

Please list leadership positions in any organizations, including ALA & YALSA: *

Please list leadership experiences in any boards, committees, or groups relevant to the elected position that you are seeking.

Please describe in detail the contributions that you have made to the groups listed above: *

How many years of experience do you have working with young adults? *

Please describe in detail any YA Continuing Education and Development experience that you have: *

Please summarize any accomplishments, awards, or recognition: *

Include honors, publications, presentations, leadership roles, etc.

What specific skills or attributes will you bring to the Education Advisory Committee? *

In particular, skills and knowledge that help advance YALSA's advocacy goals.

Do you have any known or perceived conflict of interest that would impact your eligibility to serve on the EAC? *

Not Sure

Yes

Please review the Board Conflict of Interest Disclosure Statement at http://www.ala.org/yalsa/aboutyalsa/yalsahandbook/boardcoip.

If you said yes, please specify your conflict:

What is your ethnicity? (optional)

What is your gender? (optional)

Do you work in an urban or rural location? (optional)

What type of setting do you work in: school, public, academic? (optional)

Leave this field blank