LeadUS Mentoring Program 2015-16

Colorado West Performing Arts Company Board of Directors Applicant Form

Western Colorado's Premier Professional Ballet/ Dance Company
Personal Information
Name

Last Name First Name
Date

Month Day Year
Date
Email
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Home Phone
Birth Date

Month Day Year
Gender Identity
Nationality
Business/Work Information
Title/ Profession
Company Organization
Email
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Work Phone
Extension
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 details 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 CWPAC?
Please detail your interest in joining this Board
What type of Board tasks do you prefer?
Directors of the CWPAC Board might take on special projects, in addition to their Board responsibilities, to assist CWPAC in our performing arts workshops, social change and scholarship initiatives. 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 theamount raised? Are you comfortable playing an active role in assisting CWPAC with fundraising efforts?
How much time would you have to dedicate to CWPAC (a week, a month, etc…)?
After your application has been reviewed you may be asked to interview in order for us to better get toknow you. Please have a list of references available upon request. Thank you for your interest.I certify, by my signature, that the information contained within this application and all supportingdocuments (i.e., resume, recommendation letters, etc.) is true, accurate, and complete to the best of myknowledge. An electronic signature is accepted. Signature________________________ ___________ __Date_____________ Colorado West Performing Arts Company, does not discriminate on any basis including race, sex, age, religion,
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Colorado West Performing Arts Company Board of Directors Applicant Form

Personal Information

Business/Work Information