LeadUS Mentoring Program 2015-16

Board of Directors Applicant Form

STEP for Pets is a companion animal organization providing temporary shelter and care for pets of those escaping domestic and sexual violence. We believe that survivors of domestic violence and sexual assault should be encouraged to seek safety without giving up their companion animals. Our goal is to reduce the number of people and pets trapped in violent situations, keep pets out of the shelter, and encourage safety and autonomy for survivors and their pets. Our services for companion animals of survivors of domestic and sexual violence are dedicated to the continued safety and well-being of companion animals and reuniting them with survivors once ready. We solely exist to facilitate easier, safer transitions for survivors of domestic and sexual violence and their pets. Our Board of Directors will be critical in our success, as they will be responsible for Board Building and Governance, Fundraising, and Community Outreach.
Personal Information
Name

First NameLast Name
Birthdate

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Email
Address

Street Address

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CityState / Province

Postal / Zip Code
Phone Number
Demographic Information
Place of Birth
Gender Identity
Ethnicity
Nationality
Business/Work Information
Title/Profession
Company Organization
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list your current and past Board experiences
What are your current associations and/or club affiliations (include titles if possible)
Please list your skills and expertise
What is your educational background?
Please describe in detail some of your greatest strengths and weaknesses
What do you feel is essential to ensure that the Board and staff are successful in attaining the goals for this organization?
What experiences, expertise, connections, or resources would you bring to STEP for Pets?
Please detail your interest in joining this Board
What type of Board tasks do you prefer?
Directors of the STEP for Pets Board might take on special projects, in addition to their Board responsibilities. Please let us know if you have any specific project ideas you would like to propose.
Have you ever been engaged in any specific fundraising efforts? If so with whom, how, and what was the amount raised? Are you comfortable playing an active role in assisting STEP for Pets with fundraising efforts?
The STEP for Pets Board will initially have 3 standing committees: (1) Board Building & Governance, (2) Fundraising, & (3) Community Outreach. Please check all that you would be interesting in joining.

Other
How much time would you have to dedicate to STEP for Pets (hours/week, hours/month)?
After your application has been reviewed you may be asked to interview in order for us to better get to know you. Please have a list of references available upon request. Thank you for your interest.

I certify, by my submission, that the information contained within this application and all supporting documents (i.e., resume, recommendation letters, etc.) is true, accurate, and complete to the best of my
knowledge.

STEP for Pets does not discriminate on any basis including race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, disability, or age.
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Board of Directors Applicant Form

Personal Information

Demographic Information

Business/Work Information