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USP Officer and Trustee Candidate Application

If you wish to be considered as a potential candidate for a USP officer or trustee position, we ask you to please complete this online application and then email your resumé/curriculum vitae to . The form includes some items that are duplicative/summaries of parts of your CV. Thus, to facilitate completion of the form, you may wish to have your curriculum vitae or resumé and a brief biography available for reference.

NOTE: All bold fields are required.

All applications must be received by USP by November 30, 2009.

Candidate Information

Prefix:

First Name:

Last Name:

M.I.:

Degrees:

Company/Organization:

Department/Division:

Title:

Street Address:

City:

State:

Zip/Postal Code:

Country:

Telephone (work):

Telephone (home):

Email Address:



Please consider me for the following Board position(s).
(Check all that apply)

  1. President
  2. Treasurer
  3. Trustee Representing Pharmaceutical Sciences
  4. Trustee Representing Medical Sciences
  5. Trustee Representing the Public
  6. Trustee at large


Concurrent and Past Professional Positions:

Organization:

Date:

Title:

Area of Responsibility:



USP Experience:

Date:

Area of Responsibility:



Other Board Service:

Organization

Date

Area of Responsibility



Other scientific and non-scientific organization memberships:

Organization

Date

Area of Responsibility



Education:

School

Degree(s)

Certification(s)

Program

Years

If elected, would your employer support your participation and appreciate that you will be obligated to observe the confidentiality, conflicts and other rules that are applicable to USP volunteers, and that you may have to attend meetings and devote time and potentially other resources to USP Board assignments?

  1. Yes
  2. No
Other experience that will benefit USP:

Statement of Interest:
Please indicate the reason(s) why you wish to serve as a USP Officer or Trustee

Special professional or scientific interests:

Biography:
Please copy/paste your brief biography here.


To complete the application process, please click the "Send Application to USP" button below, a return email will acknowledge receipt and ask you to attach your resumé/curriculum vitae to and send to .