Designation college: ___________________________________
Number of positions to be filled: __________
Executive director of: __________(Name of institution(s))__________
I, the undersigned, the officer in charge of the designation process, declare that on ________________ the following candidate(s) was (were) designated to the position of member of the board of directors of the above-mentioned institution(s):
( ) The number of candidates was lower than or equal to the number of positions to be filled.
( ) The number of candidates was higher than the number of positions to be filled, and the designated candidate(s) received the greatest number of nominations or votes.
( ) Due to an equal number of nominations or a tie vote, the candidate(s) ____________________ was (were) designated in a draw held on __________
Signed in ____________________, on ____________________
Name of designation officer