NAMSS 2025 Board of Directors Self-Nomination Form

All self-nominations for the 2025 NAMSS Board of Directors must be submitted using this online submission site by the deadline of Friday, May 3, 2024.

You can save and resume your form and will receive a link to resume your form that will be valid for 30 days.

PLEASE NOTE UPLOADS CANNOT BE SAVED. Once you get to the Nominee Statement page, you must finish the self-nomination form in one sitting to avoid losing any uploads.

*For ease of use, have all required documents prepared and complete the self-nomination form in one sitting.

Nominee Statement (maximum 500 words)
Nominee Biosketch (maximum 1000 words)
Signed NAMSS Volunteer Leader Agreement and Conflict of Interest Disclosure Form
Signed Campaign Policy Agreement
Completed Leadership Self-Assessment (narrative should be added on page three)
A high-resolution professional color headshot

Additional Requirements:

The candidate must provide names and contact information for three references from the following (please note: current Board members may not serve as references):

One peer reference
One reference from a state leader or committee chair familiar with their volunteer experience
One supervisor reference

Peer and State/NAMSS leader references must complete a Reference Leadership Assessment form.

Please note: It is the responsibility of the candidate to share the link to the online form with their references, and to ensure they are submitted by May 3, 2024. If both Reference Leadership Assessment forms are not submitted by May 3, 2024, the candidate's application will not be considered complete.

Please review the entire Director-at-Large or Secretary-Treasurer job descriptions before submitting your nomination.

Scoring & Ranking Information

All candidates are scored based on the following scale:

Education (Weight 10%)
High School = 1
Associates = 4
Bachelors = 8
Masters + = 10

Professional Experience (Weight 10%)
0-4 year = 1
5-10 years = 4
11-20 = 8
21+ = 10

State Board Experience (Weight 15%)*(Chapter experience does not qualify)
Committee Member/Other = 2
Committee Chair = 6
Board of Directors = 10

NAMSS Experience (Weight 10%)
Committee Member = 6
Committee Chair = 8
Board of Directors = 10

Contributions to the Profession (Weight 5%)
None = 0
Awards/Recognition (given by NAMSS, state association and/or a related healthcare organization)= 6
Published (in Synergy, your own healthcare facility and/or a related healthcare publication) = 8
Speaker/Presenter (at a NAMSS national, state or local event or a related healthcare event) = 10

Adherence to Principles of Leadership (Weight 20%)
Very Weak (1) = 0 points
Weak (2) = 0 points
Average (3) = 10 points
Strong (4) = 15 points

Candidate Interview (Weight 20%)
Very Weak (1) = 0 points
Weak (2) = 0 points
Average (3) = 10 points
Strong (4) = 15 points
Very Strong (5) = 25 points

References (10%)
Very Weak (1) = 0
Weak (2) = 0
Average (3) = 10
Strong (4) = 15
Very Strong (5) = 25

Position Choice

For which position are you applying?*

Nominee Information

Nominee Name*

First Name

Last Name

Credentials*

Please enter your credentials in the order you would like them to appear. e.g. CPCS, PhD would populate as Jane Doe, CPCS, PhD

Certifications and Degrees as you would like them to appear on the ballot if selected*

Employer*

Mailing Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Nominee Email*

Nominee Work Phone*

Nominee Cell/Home Phone*

Education (check all that apply)*

High School Diploma Associate's Degree Bachelor's Degree Post-Graduate Degree

Other:

What year did you begin working in the Medical Services profession?*

How many years have you been working in the Medical Services profession?*

0-4 Years 5-10 Years 11-20 Years 21+ Years

Leadership Experience - State Association Involvement

STATE EXPERIENCE

What involvement have you had with your State Association? For each appointment, please indicate the following: the State Association name, the Committee/Board you served on, the position you held on that Committee/Board, and the years you held this position. PLEASE NOTE: Only include state level experience. Chapter experience should not be included.

State Appointment 1

State Appointment 2

State Appointment 3

State Appointment 4

State Appointment 5

State Appointment 6

Members of a State Association Board of Directors must complete their term before they can assume the duties of a NAMSS Board position.

I attest that if elected, I will not be serving as a State Association Board Member during my term on the NAMSS Board

Please include the contact information of a reference that NAMSS may contact to verify your state involvement:

State Contact Name

First Name

Last Name

State Contact Email

State Contact Phone

Leadership Experience - NAMSS Involvement

NAMSS EXPERIENCE

What involvement have you had with NAMSS? For each appointment, please indicate the following: any position you held on the NAMSS Board and the years you held this position and/or the Committee you served on, the position you held on that Committee, and the years you held this position.

NAMSS Appointment 1

NAMSS Appointment 2

NAMSS Appointment 3

NAMSS Appointment 4

NAMSS Appointment 5

NAMSS Appointment 6

Please include the contact information of a reference that NAMSS may contact to verify your NAMSS involvement:

NAMSS Contact Name

First Name

Last Name

NAMSS Contact Email

NAMSS Contact Phone

Leadership Experience - Job/Community Related

LEADERSHIP EXPERIENCE

Please list any leadership experience from your current or former jobs within the past 5 years. Please include any responsibilities such as managing people (including number and level), managing organizational assets with corresponding budgetary authority, managing projects with organizational scope of such projects, and the level within the organization to which you are accountable.

Role 1

Role 2

Role 3

Role 4

Role 5

Role 6

Identify other past and present leadership positions held with related organizations or community groups to further demonstrate your experience

Nominee Statement

Each nominee must submit a nominee statement, not to exceed 500 words. The statement should identify and describe why you are interested in serving on the NAMSS Board of Directors. YOUR RESPONSE WILL BE INCLUDED ON THE SLATE AS WRITTEN IF SELECTED. Please ensure all punctuation and grammar is correct. The statement should be directed towards the NAMSS membership.

Upload Nominee Statement*

No File Chosen

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Nominee Biosketch

Please provide a biosketch (no CVs please), not to exceed 1000 words, highlighting special professional training, skills, or hobbies that you could bring to the NAMSS Board of Directors. The biosketch should also focus on your professional qualifications and strengths. Your response will only be shared with the NAMSS Nominating Committee and/or Board.

Upload Nominee Biosketch*

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NAMSS Principles of Leadership

The NAMSS Leadership Selection Committee has identified 4 distinctive principles that a NAMSS Volunteer Leader should exemplify in their professional lives:

CONSTRUCTIVE RELATIONSHIPS - Builds and maintains professional networks (relationships) that are characterized by mutual concern and respect and serve to improve or promote strategic development.

STRATEGIC THINKING - Ability to think strategically, challenge current beliefs/mindsets and bring tough issues to the surface even when doing so is uncomfortable; pushes for effective plans that are in line with the associations goals and objectives.

PASSION AND VIGOR - Serves as an ambassador for the association and demonstrates boundless enthusiasm for NAMSS mission, vision and goals. Is self-aware and able to successfully balance professional and personal demands.

INTEGRITY - Demonstrates consistent commitment to honesty and truthfulness; holds themselves and others accountable for acting with integrity and does the right thing even when it may be hard to do.

These four principles have been translated into a "NAMSS Leadership Self-Assessment for Board Service". You must complete the self-assessment and include the required narrative. This must be submitted as a single document and the narrative should be included as the third page of the self-assessment document. The narrative should not exceed 250 words.

Upload your completed self-assessment, including the required 250 word narrative.*

No File Chosen

File uploads may not work on some mobile devices.

Volunteer Leader Agreement

When serving as a Volunteer Leader, I acknowledge that I have a fiduciary duty to act in the best interest of NAMSS. That means that I must put the interests of NAMSS above my own personal interests when serving in this role.

In order to be eligible to be nominated, elected, or appointed, I agree to the Essential Requirements of Serving as a Volunteer Leader, as set forth in the NAMSS Volunteer Leader Agreement. By clicking "Agree and Continue" you acknowledge that you have submitted the Volunteer Leader Agreement Online Form, which includes the Conflict of Interest Disclosure Statement.

*

Agree and Continue

NAMSS Campaign Policy Agreement

Campaigning is defined as participating or intervening in any political campaign on behalf of, or in opposition to, any candidate for a NAMSS elected office. NAMSS has identified a strict set of guidelines that address the actions that will be allowed by and for a candidate of an open Board position.

In order to be eligible to be nominated, elected, or appointed, I agree to abide by the NAMSS Campaign Policy and Procedures.

Upload Signed NAMSS Campaign Policy Agreement*

No File Chosen

File uploads may not work on some mobile devices.

Headshot

Please submit a professional color headshot to be used for the slate if selected. The file name must include your first and last name.

Upload Headshot*

No File Chosen

File uploads may not work on some mobile devices.

Reference Assessments

Candidates for the Director-at-Large or Secretary-Treasurer position must provide contact information for THREE references (1 supervisory reference, 1 peer reference and 1 state or NAMSS leader reference required). Your supervisory reference may be asked to participate in a phone interview with members of the Leadership Selection Committee pending review of your application. Peer and State/NAMSS leader references must complete a Reference Leadership Assessment form.

- 1 Supervisory Reference: This reference should be the person that is responsible for the performance management process who is able to attest to the applicant's ability to commit to travel and time requirements.

- 1 Peer Reference: Suggested references include a professional colleague, industry partner, legal counselor or other industry consultant.

- 1 State or NAMSS Leader Reference: This reference should be the person who can speak to your leadership abilities and experience volunteering with your State Association or NAMSS.

All individuals provided should be able to attest to the candidate's ability to abide by the NAMSS Principles of Leadership, leadership skills, leadership style and overall professional experience and accomplishments.

Current NAMSS Board members and Leadership Selection Committee members cannot serve as peer references.

Individuals may only serve as a reference for one candidate.

Candidates for either the Director-At-Large or Secretary-Treasurer positions may not serve as a reference for other candidates.

NAMSS may also request performance evaluations from state leadership (where state leadership experience is indicated) and/or relevant NAMSS committee chairperson (where committee experience is indicated).

Supervisor Reference Name*

First Name

Last Name

Supervisor Reference Email*

Peer Reference Name*

First Name

Last Name

Peer Reference Email*

State or NAMSS Leader Reference Name*

First Name

Last Name

State or NAMSS Leader Reference Email*

By clicking "Agree and Continue" you acknowledge that it is the candidate's responsibility to share the Reference Leadership Assessment online form link with all three references. It is also the candidate's responsibility to have each reference submit the online form by May 3, 2024.

Agree and Continue

Statement of Consent

I consent to serve on the NAMSS Board of Directors, if elected by the membership, for the term relevant to the position for which I have been nominated. I understand that NAMSS must verify my information and evaluate my qualifications based on an established ranking scale. I hereby release from liability NAMSS, Leadership Selection Committee members, and staff for any acts performed in good faith in connection with the election process. I further release from liability all persons who provide any information in good faith and without malice to NAMSS, Leadership Selection Committee members, or staff concerning my professional character.

Members of the Board of Directors will not be eligible for compensation for any services rendered to or on behalf of NAMSS during their term of office. This includes but is not limited to honoraria for any speaking engagements. However, reasonable reimbursement for travel and NAMSS business related expenses is acceptable.

I attest that I have read the above information and agree to terms*