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Measure Development Consumer/Family Panel

Measure Development Consumer/Family Panel Nomination Form

American Psychiatric Association Consumer/Family Panel Nomination Form
Thank you for nominating yourself or a candidate to the American Psychiatric Association Measure Development Consumer/Family Panel.

To complete this nomination form, you will be prompted to attach the candidate's (or your) completed conflict of interest form, CV, and letter of support or personal statement.
1. Nomination Checklist
2. Please complete the following. *This question is required.
3. Preferred Contact Information *This question is required.
4. If you would like your administrative assistant copied on correspondences, please include their contact information:
5. Which category best describes your current professional role? (Please select one) *This question is required.
To help us select a diverse membership, we as that you provide the following voluntary demographic information:
6. Age Group
7. Race/Ethnicity
8. Language
9. If seated to the quality measure technical expert panel, I affirm that I am able to participate in all panel activities and meetings. *This question is required.