Board Member Application

Prospective Board Member Confidential Application
Thank you for your interest in serving on the AwAction Network Inc. Board of Directors. We solicit the following information from interested applicants. The Committee will review your application and follow up with you.
Applicant Basic Information
Applicant Name *

First Name Last Name
Business Address *

Street Address

Street Address Line 2

City State

Zip Code
Email *
example@example.com
Phone Number *
Please, enter your phone number
Preferred Communication *

Phone Email
Organization Website (if applicable)
Enter your company website, if available

If you had the opportunity to address the AwAction Network Inc. Governance Committee and describe yourself and why you should be selected for a position on the Board, what would you say? *

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Did anyone refer you? *

Yes No
If yes, who referred you and in what context?
Are there any other additional disclosures you would like to make regarding any document you received, policies in place, or vision, mission, value statements that would be important for us to know in advance? *

0/30

Committee Information
In which committee would you like to serve? *

Executive Development Finance Governance Public Relations If you have multiple interests, list them in preferential order(no more than 3)
Would you like to serve as a chair in your chosen committee?

Yes No
What value will you add to the chosen committee(s)? *

0/30
Select your strengths from the list
Familiarize yourself with the role and responsibilities,commitment, and requirements of board members, committees, and chair.
Should be Empty:

Prospective Board Member Confidential Application