LeadUS Mentoring Program 2015-16

Board and Staff Member Applicant Form
Personal Information
Name*

First NameLast Name
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Birth Date*

MonthDayYear
Demographic Information
Gender
Ethnicity
Nationality
Work Information
Title/Profession
Company Organization
Education Information
Highest Level of Education
Field of Interest/Expertise
Other Information
Please list any military affiliation.*
If none, please enter 'n/a.'
Do you have a criminal record? If yes, please elaborate.*
If none, please enter 'n/a.'

General Interest
What do you know about our organization? Why are you interested in committing your time and energy to us?*
What experience do you have that is related to our mission or that will be of value to our organization?*
What about our mission excites you?*
What do you expect from the organization? *
Why do you desire to be a board member?*

Experience & Resources
What other board experiences have you had?*
Fundraising is a significant obligation of board service. What can you tell us about your experience in fundraising? *
Board members bring experience, wisdom, strategic thinking, and their connections. What can you tell us about yours?*
Who in your network can you involve in the organization?*
What other resources can you contribute? This could be money, assets, property, etc.*

Qualities & Characteristics
What do you think are the characteristics of a great board member?*
What personal qualities can you bring to the board?*
What motivates you as an individual? *
What do you hope to achieve within your term limit?*
What role would you hope to play on the board? How do you see yourself fitting in and working with other board members?*
How do you feel about performance evaluations? How comfortable are you with having your work reviewed?*

Commitment
How much time can you commit to the organization? What kind of autonomy do you have over your calendar? *
What factors in your life might limit your ability to serve?*
Are you fully aware of the personal financial commitment?*
Would you have any conflicts of interest?*

Board and Staff Member Applicant Form