Council Member Nomination Form

You must be a continuous giver to the Benevolent Fund to be considered for the council. Nomination forms must be signed by the nominee, and the nominee’s supervisor must agree to support the nomination for it to be valid.

First Name(*)

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Last Name(*)

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Address(*)

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City(*)

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Zip Code(*)

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Phone Number(*)

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Email (*)

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UAB Entity(*)

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Department(*)

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Position(*)

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Employee Status

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Brief statement on why you want to serve on the Benevolent Fund Council(*)

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Authorization(*)

By checking this box, I state that I am a regular full-time or part-time employee, a continuous Benevolent Fund contributor, and am willing and able to represent my unit on the UAB Faculty and Staff Benevolent Fund Council.

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Supervisor Approval

Supervisor Name

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Supervisor's Phone Number

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Recaptchav2(*)

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A Benevolent Fund council member is expected to attend regular meetings on the third Tuesday of every other month and serve on at least one committee, which could meet up to once a week in addition to the regular Council meetings. By signing this form, I further acknowledge that my supervisor has approved for the necessary time commitment described above.