Board of Directors Application

Briefly describe why you would like to join our Board of Directors.

Employer/Company

Job Title

Roles and responsibilities you currently have at your place of employment

Which of your skills would you like to utilize on the board? Check all that apply:

Other skill(s) you would like to utilize:

What would you like to get for yourself out of your participation on the Board, e.g., what types
of experiences, skills to develop, interests to cultivate for you, etc.?

If you join the Board, you agree that you can provide at least 2-4 hours a month in attendance to
Board and Committee meetings, and that you do not have any conflict-of-interest in participating
on the Board.

I have read and agree to the expectations and responsibilities of the Board of Directors membership.

If you are not selected as a member of the Board, or if you decide not to join, would you like to
be a volunteer to assist our organization in various ways that match your skills and interests?