Board of Directors Application
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Briefly describe why you want to be on the Board of Directors at Samaritan House.
Have you served (or currently serving) on other non-profit boards? If so, please list your role(s) below.
What is your experience in fundraising?
What is your experience in finance?
Which of your skills would you like to utilize on the Board? Check all that apply.
Board Development
Financial Management
Strategic Planning
Fundraising
Marketing
Evaluation
Volunteer Management
Facilities Management
Community Networking
Program Development
Other
List other skills if applicable
If you join the Board, you agree that you can provide at least 2 hours a month in attendance to the Board and committee meetings and that you do not have any conflict of interests in participating on the Board.
Yes
No
If you are not selected for the Board of Directors, or if you decide not to join, would you like to volunteer to assist Samaritan House on a committee?
Yes
No
Signature
Date
-
Month
-
Day
Year
Date
Employer
Linked In Profile
Submit
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