LeadUS Mentoring Program 2015-16

Board of Directors Application
Personal Information
Name*

Last NameFirst Name
Date*

MonthDayYear
Date
Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Birth Date*

MonthDayYear
Demographic Information
Place of Birth
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Gender Identity*
Ethnicity*
Nationality*

Hispanic/LatinoNot Hispanic/Latino
Business/Work Information
Title/Profession
Company/Organization*
Please list your current and past Board experiences
What are your current associations and/or club affiliations (include titles if possible)
Please list your skills and expertise
What is your educational background?
What do you feel is essential to ensure that the Board and staff are successful in attaining the goals for this organization?
What experiences, expertise, connections, or resources would you be willing to bring to OnPurpose?
Please detail your interest in joining this Board
What type of Board tasks do you prefer?
The OnPurpose Board will initially have 4 standing committees: (1) Board Building & Governance, (2)Development, (3) Finance & Human Resources, and (4) Programs. Please check all that you would be interesting in joining.*

Board Building & GovernanceFinance & Human ResourcesDevelopmentPrograms
How much time would you have to dedicate to OnPurpose (a week, a month, etc…)?*
OnPurpose Enrichment Inc.'s Board is an exciting and engaged working board. Board members are required to participate in a minimum of 4 quarterly meetings (virtual), one annual face-to-face event (i.e., fundraising event, board fellowship, partnership meeting, or siimilar) which occur outside of regular board meetings (this can happen by phone or internet). Board members are expected to be timely and present at every meeting with a maximum of two absences from board meetings.

Between virtual board meetings and the annual event, hours of commitment would probably vary between 5-7 hours per year. Board members are also encouraged to participate in raising at least $1,000 in annual funds OR making an annual gift in the amount of at least $500 to OnPurpose Enrichment, Inc.

Board members are expected to commit to the role for a minimum of two years.
Will you be able to make this commitment to OnPurpose Enrichment, Inc.?

YesNo
I certify, by my signature, that the information contained within this application and all supporting documents (i.e., resume, recommendation letters, etc.) is true, accurate, and complete to the best of my knowledge. An electronic signature is accepted.
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Board of Directors Application

Personal Information

Demographic Information

Business/Work Information