Young Professionals Network Nomination Form

Young Professionals Network Nomination Form
Thank you for your interest in joining the American Heart Association’s Young Professionals Volunteer Group.

Membership Requirements:

· Ages 21 – 40 and passionate about heart health

· Active participation in two events or initiatives per year

· Represent AHA values with professionalism and enthusiasm

· Stay connected via quarterly meetings and group updates

· Annual $1,000 individual fundraising goal

Please complete the form below to help us learn more about you and your interest in supporting heart health in your community.
I would like to...
Name of person making nomination

First NameLast Name
Contact Information:
Name

First NameLast Name
Preferred Name (if different)
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Professional Details:
Current Employer
Title
Industry
LinkedIn Profile (optional)
Demographics (optional but appreciated):
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender Identity
Race/Ethnicity
Volunteer Interests:
What areas of volunteering interest you most? (Check all that apply)

Other
Are you interested in joining a committee or taking on a leadership role?
Availability:
How many hours per month can you commit to volunteering?
Preferred days/times for volunteering (e.g., evenings, weekends)
Skills and Experience:
Please share any relevant skills, certifications, or past volunteer experience that may support our mission.
Why Heart Health?:
What motivates you to support the American Heart Association and heart health?
Consent and Communication:
I agree to receive communications from the American Heart Association regarding volunteer opportunities and updates. (I understand that my information will be used solely for volunteer engagement purposes.)
Once submitted, a member of our team will follow up with next steps and upcoming opportunities. Thank you for your commitment to making a difference.

For more information, please contact Nikki Smith: [nikki.smith@heart.org](mailto:nikki.smith@heart.org)
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