Seeking energetic, passionate leaders!

*Board Member Application*

Become a driving force for good in your community by joining our non-profit Board of Directors.

Name

First Name

Last Name

Phone

(###)

###

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Background Information

Current Employment Status

Employer Name (if applicable)

Current Occupation

Number of years with current employer

Number of years in current occupation

What is your professional background?

What other volunteer positions have you held?

Please list any degrees you have earned and from what institution.

Mission Alignment

In what ways have you interacted with our organization before applying to be on the board? (Examples: Committee member, Club member, parent, donor, event attendee, etc.)

Why is our mission important to you?

Why do you want to be on our board?

Governance

Do we have your permission to contact the organizations above to ask about your board service with them?

Yes

Not applicable

Each year, every board member is required to disclose any potential conflicts of interest. Please describe any conflicts of interest you would need to disclose if you joined the board.

Board meetings are scheduled for the third Monday of each month from 5:30 - 7:00 pm. Are you available at this time?

Yes

The minimum expectations for board members are listed below. Please confirm your ability and willingness to meet each requirement

I will attend and actively participate in at least 75% of the board meetings.

I will make an annual financial gift at a level that is personally significant.

I will raise $500 per year for the organization by direct solicitations, selling tickets to events, or other fundraising activities.

I will serve on at least one committee and attend at least 75% of the meetings.

If you have served on a board before, please provide the name, dates of service, and reason for leaving for the three most recent board positions you have held.