Unlimited Potential Board Application Form
Thank you for your interest in joining the Board of Directors. Please fill out this application as completely as possible. Contact kwardlaw@upbrazosvalley.org with any questions.
Candidate's Information
Name
First Name
Last Name
Preferred Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Occupation
Emergency Contact
First Name
Last Name
Emergency Contact Phone Number
-
Area Code
Phone Number
Emergency Contact Email
example@example.com
Relationship to candidate
Briefly describe your background and interests.
0/150
How long have you lived in the Brazos Valley community?
Educational Background
*
Current or Most Recent Employment
*
Past Employment History
Format: Employer/Position/Date Range/Summary of Duties
Relevant Nonprofit Board Experience
*
Other Relevant Experience
*
Why are you interested in serving on the Unlimited Potential Board of Directors?
What relevant skills or expertise do you possess that would help the Board of Directors function more effectively?
Please select all of the following you have expertise or experience in.
Other information and comments
Please select the most accurate response.
Please Select
I do have an exisiting conflict of interest.
I do NOT have an existing conflict of interest.
UP Board Members refrain from positions considered as or appearing as a conflict of interest, whether financial, professional, or personal.
If yes, please explain.
Are you currently in a paid position with a nonprofit? If so, please explain.
Have you volunteered for UP before?
Yes
No
Have you held a leadership position on a board before?
Yes
No
If yes, where?
Name & Signature
*
*My signature certifies that all of the information provided is true and accurate to the best of my ability.
Date
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: