ࡱ> =?<_ bjbjCC $)D\)D\o VV4hBV$zzzzzGIIIIII$R m"mVVzz3jV8zzGGzyn9v30 `  $mm > :  [Name of Organization] Board of Directors Candidate Application  Date ______________________________ Name ___________________________________________________________ First MI Last Familiar name Residence Address ___________________________________________________________ Phone ______________________________ E-mail ________________________ Employer Name ____________________________________________________________ Your title _________________________________________________________ Address ___________________________________________________________ Phone ______________________________ E-mail ________________________ Type of business or organization ________________________________________ Primary service(s) and area/population served _______________________________ Preferred method of contact ( ) Work ( ) Residence Please list boards and committees that you serve on, or have served on (business, civic, community, fraternal, political, professional, recreational, religious, social). Organization Role/Title Dates of Service _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Education/Training/Certificates _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Optional Have you received any awards or honors that youd like to mention? _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ How do you feel [name of org] would benefit from your involvement on the Board? _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Skills, experience and interests (Please circle all that apply) Finance, accounting Personnel, human resources Administration, management Nonprofit experience Community service Policy development Program evaluation Public relations, communications Education, instruction Special events Grant writing Fundraising Outreach, advocacy Other _______________________ Other _______________________ Other _______________________ Please list any groups, organizations or businesses that you could serve as a liaison to on behalf of [name of org]. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Please tell us anything else youd like to share. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Thank you for applying     Provided under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International license. 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