NHSA Board of Directors - Board Certification Form

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Certification Form to be completed by the Regional President or designee

Head Start Regional Associations are required to certify the Representatives they elect to the National Head Start Association Board of Directors.  Please complete this form to provide NHSA with contact information of your Board Representatives and verify with the Representative for accurate records.  For questions in completing this form or feedback on improving this form, please contact (703) 399-2410.

NHSA Board Term of Office: Two-year Term; Fiscal Year: July 1-June 30
NHSA's by-laws do not set term limits for Directors of the Board.


This is the actual date of election for the representatives below.

REPRESENTATIVE CONTACT INFORMATION

Director Representative

















If known, a 5 digit (XXXXX) number issued by NHSA.

If known, a 6 digit (XXXXXX) number issued by NHSA.

Staff Representative

















If known, a 5 digit (XXXXX) number issued by NHSA.

If known, a 6 digit (XXXXXX) number issued by NHSA.

Parent Representative

















If known, a 5 digit (XXXXX) number issued by NHSA.

If known, a 6 digit (XXXXXX) number issued by NHSA.

Friend Representative

















If known, a 5 digit (XXXXX) number issued by NHSA.

If known, a 6 digit (XXXXXX) number issued by NHSA.

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Regional Reporting Responsibility
Regions have the opportunity to report on news, events, issues, and concerns to the Region at each Board Meeting of the NHSA Board of Directors.  Additionally, this process allows the Region an opportunity to propose recommendations for NHSA to pursue.  We ask the Region to submit a Regional Report due a minimum of two weeks before each Board Meeting.  Please provide the contact information for the individual responsible for submitting the Regional Report to NHSA. 
Contact Information










Certification


Enter full name to provide signature











Contact Information