Faculty Committee Nomination Form

Complete this form for each person you would like to nominate to the Faculty Committee.

Please select your member organization. If your organization isn't on this list, please contact the NIPTE office.

Nominator Information

Please provide your information below.
Only department head's or immediate supervisors can nominate someone for the NIPTE Faculty Committee

Nominee Information

Please enter the information for the person you would like to nominate to the Faculty Committee. This person must be from your organization as named above.

Sign and submit

The NIPTE office will forward the nomination acceptance form to the nominee once the nomination is approved. Thank you!