Applicant Information

Dear Prospective Board Member, We thank you for your interest in the ANA Board of Directors. You can become a part of the future of this great profession of Naprapathic Medicine. Without your participation and support, the profession could not fulfill its commitment to helping every Naprapath in this country obtain the necessary and vital training to become Doctors of Naprapathic Medicine. Your board membership means that the American Naprapathic Association can continue to be an active and vital part of the health care community and potentially break down barriers that Naprapaths have faced in the past. Your participation and support make these and other valuable opportunities possible. Every board member strengthens the profession's public profile. Your involvement is important and very much appreciated. We look forward to your application on the ANA BODs.
***Used for Statistic and Demographic Information only***
***Used for Statistic and Demographic Information only***
***Used for Statistic and Demographic Information only***
***Used for Statistic and Demographic Information only***
***Used for Statistic and Demographic Information only***
***Used for Statistic and Demographic Information only***
***We will not share or disclose this information (for ANA internal use only)***
***We will not share or disclose this information (for ANA internal use only)***
***We will not share or disclose this information (for ANA internal use only)***
***We will not share or disclose this information (for ANA internal use only)***
***We will only share office information with your consent***
Click or drag files to this area to upload. You can upload up to 2 files.
If yes has been marked and there is no file upload, your application is considered incomplete.

Educational Information

The American Naprapathic Association does not discriminate on the basis of race, religion, creed, sex, age, marital status, disability, national origin or sexual orientation in its educational programs, activities or employment practices. List all secondary and post-secondary institutions attended, in chronological order, beginning with the most recent attended.
Click or drag files to this area to upload. You can upload up to 4 files.
Please upload any and all medical or other professional licenses here.

Employment History

The American Naprapathic Association does not discriminate on the basis of race, religion, creed, sex, age, marital status, disability, national origin or sexual orientation in its educational programs, activities or employment practices. You may provide additional information which you feel might be relevant to the Board Member application process. This could include your Curriculum Vitae (CV), resume, record of community service and leadership, personal achievements, academic distinctions, and /or a brief letter outlining your reasons for choosing to serve on the ANA board.
May write self-employed or "n/a"
Ok to leave blank
Ok to leave blank
Click or drag files to this area to upload. You can upload up to 2 files.

Additional Licensing Information

Click or drag files to this area to upload. You can upload up to 4 files.
Click or drag files to this area to upload. You can upload up to 2 files.
If more than once license has been disciplined, please upload separate explanations for each

Uploads / Additional Documentation

Please upload pdf formats of the following:
Click or drag files to this area to upload. You can upload up to 2 files.
Government Issued ID must also display an address. ***We will not share or disclose this information (for ANA internal use only)***

Please Remember to Complete Background Check Authorization Consent Form

Please Remember to Complete Conflict of Interest Disclosure Form

Please provide the link for your "Linked In" profile below ***leave blank if not applicable***
Please provide the link for your business "Linked In" profile below ***leave blank if not applicable***
Please provide the link for your website ***leave blank if not applicable***
Please tell us any other volunteering commitments that you may have. ***Completion of ANA Conflict of Interest Disclosure Form will be required in application process.***
May save application while completing other forms before final submission.

Thank You for completing the ANA Board of Director Application.

We will be in contact with you regarding next steps after the board's full review of your application. Please double check that you have made a selection for each box and completed all additional forms needed for this application. Please be sure to date and submit your form.