Executive Council Candidacy

Declaration of Candidacy

Date*
MM slash DD slash YYYY
CANDIDATE NAME:*
First Last
CANDIDATE ADDRESS:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
CANDIDATE STATEMENT & INFORMATION*
Candidate’s Statement and Information: LPA bylaws provide for a candidate to include such statement or information as the candidate may care to provide for and which will be furnished to the membership along with the ballots. You may write or type your statement here, or you may upload a file containing your statement and/or information below.
UPLOAD STATEMENT & INFORMATION
Max. file size: 50 MB.
Agreement to Seek Candidacy*
By submitting this form, I declare my candidacy for election to the aforementioned Louisiana Psychological Association Executive Council office. I certify that I hold the qualifications of full member in good standing. I also consent to serve and fulfill the obligations incumbent upon me should I be elected to this office.