BoardApplication

Upon completion of this application, please mail to:

Executive Director 1127 S. Laramie St.

NOMINEE FOR BOARD OF DIRECTORS OF SOUTH SIDE MISSION OF PEORIA, INC.

Name

Address

City, State, Zip

Phone (home)

Phone (cell)

E Mail

example@example.com

Why do you want to serve on the South Side Mission Board?

When did you accept Jesus Christ as your Lord and Savior and describe what that means to you?

Give name and address of church where you attend

Are you a member of this church? Yes/No If no, why not?

Were you baptized as a child? Yes/No Believers baptism Yes/No When were you baptized?

Have you read, agree with, uphold and believe: Yes/No

I. The Key Characteristics of the South Side Mission's Faith Community and Mission

A. South Side Mission's Biblical Beliefs

B. Representatives and Other Participants

C. Christian Exercise and Expression

1. As a Community;

2. Through its mission based activities.

II. Christian Community Standards for Ministry Activities

A. General Standards

B. Specific Concerns

Marriage and human sexuality

Sanctity of human life

Religious activities

C. Implementation

III. Community Standards for South Side Mission representatives

A. Rules and Expectations

Biblical Beliefs; Christian Conduct Standards; Distinctly Christian Activities

B. Noncompliance by Representatives

C. Volunteers and Contract Workers

Positions you have held in your church and explain what you actually did.

What ways do you think you can apply these positions, experiences, offices, to the activities/ministries of the Mission?

What is the name, address of firm, business, profession, or other occupation where you work?

In the scope of where you work can any of these skills be applied to your role on the Board of Directors at the South Side Mission?

Describe and explain your participation in the community in other organizations; i.e., Board memberships, civic organizations, volunteer work. Can any of these activities be useful, applicable, demonstrated or helpful in your participation on the Mission board?

Describe and explain any Spiritual Gifts or church training you may have that can be applied to Mission ministries such as Tutoring; Youth Ministry; Culinary Arts; Camp Kearney (camping and outdoor); Grant Writing; Fund Raising; or Thrift Store business development.

Have you, or are you now, volunteering at the Mission? Yes/No What did/do you do?

Are you willing to help raise money for the South Side Mission by asking people in your circle of influence for support?

Reference: for my character (name of person & phone)

Reference: for my spirituality (name of person & phone from church)

Reference: for a good family role model. (name of person & phone)

Is there anything else the Board of Directors and staff should know about you or your willingness and motivation to serve?

AFFIRMATION

I have carefully and prayerfully read the description of the Mission's purpose and duties of Board Members, and having accepted Jesus Christ as my Lord and Savior, I can personally support all the items in the Mission's Statement of Faith.

Upon becoming a member of the South Side Mission or Peoria, Inc. Board of Directors, I will keep the Mission in my prayers, attend 4 monthly Board meetings (February, May, August and November) and committee meetings to which I am assigned, and financially support $1,000 each year and/or volunteer at least 12 hours of time per year towards the Mission's ministries.

I consent and authorize South Side Mission to perform a background search. I will provide my date of birth and social security number to enable such a search.

NOMINEE'S SIGNATURE

Date