Date:

Name, Title, and Institution:

Preferred Mailing Address:

Telephone(work):

Telephone(home):

e-mail:

ALA Membership No.

Number of years you have been a member in YALSA:

Professional Experience (list previous position(s) and locations, most recent first):

Special Skills: (e.g.,accounting, PR/marketing, fiscal planning, research, refereeing, editing)

Professional Activities:
ALA and YALSA

State and Regional Associations

YALSA Committee Preference (see the list of YALSA committees, task forces, and award juries.  Please note that it is best to fill out a request for a selection committee in the Fall and a process committee in the Spring). Please list specific committees or juries. Do not state "any."

If appointed, can you regularly attend the ALA Midwinter and Annual Conferences, as is required of committee and jury members?
Yes    No

Please note that the president may appoint a replacement for a committee chairperson or member who has missed two consecutive meetings (Midwinter and Annual) of the committee, pursuant to the ALA Policy Manual. This policy does not apply to virtual members.

If no, would you consider serving as a virtual member? Virtual members do not have to attend conferences, but instead do their committee work electronically. This option is not available for selection or award committees.
Yes    No

ALA Committee Preferences
Occasionally the YALSA President-Elect has the opportunity to recommend names for YALSA members to be appinted to certain ALA committees.  If you would be interested in serving on one of these committeess when the opportunity arises, please indicate your preference.  A full list of committees and their charges can be found here.  Please check up to three committees you would be interested in serving on.

Please add any additional information you feel would assist division officers in making committee assignments.