Fermilab

Community Advisory Board

Nomination Form

Nomination for Membership on Fermilab Community Advisory Board

  • All nominations are due no later than Monday, December 7, 2009.
  • Questions? Please call (630) 840 3351
  • More information can be found at www.fnal.gov/pub/neighbors/CAB/

Membership of the FCAB will comprise approximately 20 local residents representing a wide range of interests and viewpoints. Members will be chosen by a steering committee of local community leaders from previous community boards.

Expectations of FCAB Members

Membership on the FCAB will be hard work. Members will be expected to attend all monthly meetings, participate in subcommittees, read materials and background information between meetings, and help to communicate issues with neighbors and others in the community. In addition, the FCAB will seek to find common ground where possible, requiring all members to approach each other with respect and all issues with an open mind. Total time commitment is expected to be approximately 8 hours per month.

Please answer each question fully and honestly. Personal questions are included to ensure that we convene a diverse and representative board. All contact and personal information will be kept confidential. If you are nominating another, please ensure that they aware of this nomination and willing to serve if selected.

Profile
Street
City:
State:   Zip:
Street
City:
State:   Zip:
Land:   Cell:
under 25 25-40 41-54 55 or older
under 5 5-10 11-20 21 or more
Affiliations
where you believe you would serve as an honest and appropriate representative:
  • Close neighbor
  • Educator
  • Parent
  • Student
  • Retired
  • Local government
  • Faith community
  • Minority community
  • Business community
  • Science community
  • Trade Unions
  • Agriculture community
  • Recreational community
  • Real estate community
  • Tourism community
  • Environmental community
  • Parks/open space community
  • Medical community
Relationship/Interest
(200 words or less)
(200 words or less)
   
Your Name:
   
If not a self-nomination, please provide contact information for the nominator: Phone:

Email: