Board Nomination Form
Board Position Title
Nominee's Information
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Work
Position/Title
Employer Name
First Name
Last Name
Employer Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Employer Email
example@example.com
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Does the nominee have any board member experience?
Yes
No
If yes, please provide the following
Company Name
Position/Title
Duration
Why do you think this Nominee should win the position?
What are the strengths of the Nominee?
What are the related skills of the Nominee?
Does the nominee/candidate have the following experience? Please select all that apply:
Accounting
Administration
Business
Education
Finance
Fundraising
Legal
Non-profit management
Management
Public Relations
Other
What can the Nominee add to the company by being member of the board?
Are you nominating for yourself?
Yes
No
I have read the responsibilities assigned for the position and I'll do my best to implement them. I confirm that I don't have any conflict of interest or potential that will be a hinderance in joining the board. I confirm that I will perform my duties as a board by committing to it.
Signature
Date Signed
-
Month
-
Day
Year
Date
If no, fill up the following details:
Your Name
First Name
Last Name
Your Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email
example@example.com
Does the candidate know what you are nominating him/her?
Yes
No
Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Should be Empty: