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Charlotte Lab Board Candidate Interest form

Please complete the form below. Required fields marked with an asterisk *

Valid email address*

Answer Required

First Name*

Answer Required

Last Name*

Answer Required

Are you a resident of North Carolina?*

Answer Required

yes

Phone number*

Number Required

Affiliation with Lab*

Answer Required

Parent or Guardian

Community Member - resident of Charlotte region

Community Member - place of business is in Charlotte region

Please attach a letter of interest.*

Answer Required

Choose a file or drag it here.

Please attach your resume/CV*

Answer Required

Choose a file or drag it here.