Thank you for your interest in an appointment to serve on the FCC’s Consumer Advisory Committee (CAC) from 2020-2022.  For more information about the Consumer Advisory Committee, please see its webpage:  https://www.fcc.gov/consumer-advisory-committee.

IMPORTANT:  The Commission issued a Public Notice on July 7, 2020, describing this nomination process and the qualifications and requirements for appointees to the Committee.  You must review the Public Notice before completing this online form:   Word | Acrobat

Nominations will be received until 11:59 p.m. EST, Friday, August 7, 2020.  Your nomination will not be complete until this form and all supporting documents are submitted as instructed.

The Commission is seeking nominations from consumers who wish to serve on their own behalf and from nonprofit organizations, corporations, trade associations, government agencies, and other entities from both the public and private sectors.

Organizational Nomination

This statement is limited to 3500 characters. You have 3500 characters remaining.

Proposed appointee to serve as the entity’s representative on the Committee

Name and Contact Information

Example: 555-555-5555

Resume

The proposed representative’s resume must be submitted as an electronic file in machine-readable PDF or Microsoft Word (.doc or .docx) format.  The electronic file name should include the name of the entity, the word “resume,” and the last name of the proposed representative, using should use the following naming convention:

            Example:  entityname_Resume_lastname_of proposed representative.pdf

The file may be uploaded using the widget on the final page of this form or may be transmitted as an attachment to an email to the Committee’s Designated Federal Official, Scott Marshall, scott.marshall@fcc.gov.

Statement of Qualifications

Please describe the proposed representative’s qualifications for service on to the FCC Consumer Advisory Committee, including any specific knowledge or expertise that is relevant to the Committee.

This statement is limited to 3500 characters. You have 3500 characters remaining.

Alternate Representative

Alternate Representative

Example: 555-555-5555

Resume

The proposed alternate representative’s resume must be submitted as an electronic file in machine-readable PDF or Microsoft Word (.doc or .docx) format.  The electronic file name should include the name of the entity, the word “resume,” and the last name of the proposed representative, using should use the following naming convention:

            Example:  entityname_Resume_lastname_of proposed representative.pdf

The file may be uploaded using the widget on the final page of this form or may be transmitted as an attachment to an email to the Committee’s Designated Federal Official, Scott Marshall, scott.marshall@fcc.gov.

Statement of Qualifications

Please describe the proposed alternate representative’s qualifications for service on to the FCC Consumer Advisory Committee, including any specific knowledge or expertise that is relevant to the Committee.

This statement is limited to 3500 characters. You have 3500 characters remaining.

Certification and Confirmation of Responsibilities

Dear [NAME],

We are contacting you on behalf of the Federal Communications Commission’s Consumer Advisory Committee to follow up on the submission of a form nominating [PROPOSED REP] [if applicable: and [PROPOSED ALTERNATE REP]] to represent [NAME OF ORGANIZATION] on the Committee.  We would appreciate your confirming [NAME OF ORGANIZATION]’s support for this nomination if you have not already done so.

An organization, company, or other entity nominating a representative to serve on its behalf on the Committee must submit written confirmation by an authorized person (e.g., an official of the organization, company, or other entity) that such entity wants the representative to serve on its behalf.

The nominating official must possess the executive authority or hold a sufficiently high-level position within the organization or company to select a representative whose actions will be legally binding on the organization or company.   You have been identified as the authorized nominating official at [NAME OF ORGANIZATION].

We would appreciate your submitting a letter certifying [NAME OF ORGANIZATION]’s support for this nomination of to serve on its behalf on the Committee.  For example, this confirmation may be in the following format: “I am [name], the [title] at the [insert name of company/organization], with responsibilities for [concise description of position].  My [company/organization] would like [name(s) of proposed representative(s)], who [is/are] currently [an employee of/consultant/attorney to the organization], to serve as our representative(s) on the FCC Consumer Advisory Committee.”

I would appreciate your emailing me this certification letter in PDF format from your organizational email account.  (If you have already submitted the letter, there is no need to re-submit it, and I apologize for the intrusion.)  Please contact me if you have any questions.

Thanks.

Scott Marshall
Designated Federal Officer, FCC Consumer Advisory Committee
Consumer and Governmental Affairs Bureau
Federal Communications Commission
Email: Scott.Marshall@fcc.gov
Phone (voice or relay): 202-418-2809

Please enter the name, title, and contact information of the officer or other official submitting the certification letter.

Name and Contact Information of Certifying Official

Example: 555-555-5555

The certification letter should be submitted as a file in PDF or Microsoft Word (.doc or .docx) format.  The file name should include the name of the entity, the word “certification,” and the certifying official’s last name and first initial, using the following file naming convention:

            Example:  entityname_Certification_lastname_of certifying_official.pdf

The certification letter may be submitted using the file upload widget on the final page of this form.   Alternatively, the letter may be transmitted as an attachment to an email from the certifying official to the Committee’s Designated Federal Officer, Scott Marshall (scott.marshall@fcc.gov). 

Please indicate below whether you would like the system to send an email to the certifying official identified above with instructions regarding the required certification letter to confirm the entity’s authorization of this nomination.

Confirmation that the nominating organizational entity and its representative(s), if appointed, would fulfill responsibilities as a Committee member

If the Commission appoints a representative (and, if applicable, alternate representative) to serve on the Committee on the entity’s behalf, does the entity and each prospective appointee—

Individual Nomination

Example: 555-555-5555

As noted in the Public Notice announcing this solicitation, all members are subject to an ethics review prior to service. If submitting as an individual/SGE and not as a representative of a company, organization, or other entity you are disqualified from serving on the Committee if you are a federal registered lobbyist. SGE members must file confidential employee financial disclosure forms prior to beginning their service and annually thereafter.

Resume

All nominees must submit a resume.  The resume should be transmitted as an electronic file in machine-readable PDF or Microsoft Word (.doc or .docx) format, with a file name that includes the nominee’s last name and the word “resume,” using the following naming convention:

            Example:  lastname_Resume.pdf

The file may be uploaded using the widget on the final page of this form or may be transmitted as an attachment to an email to the Committee’s Designated Federal Official, Scott Marshall, scott.marshall@fcc.gov.

Statement of Qualifications

Please describe your qualifications and reasons for seeking appointment to the FCC Consumer Advisory Committee, including any specific knowledge or expertise that is relevant to the Committee.

This statement is limited to 3500 characters. You have 3500 characters remaining.

Confirmation that you would fulfill responsibilities if appointed to serve on the Committee

If the Commission appoints you to serve on the Committee, do you—

Thank you.