CCWC Board of Directors Applcation

Board of Directors Application
Personal Information
Name*

First NameLast Name
Personal Email*
Address*

Street Address

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CityState / Province

Postal / Zip Code
Cell Phone*
Home Phone
Birth Date*

MonthDayYear
Date
Briefly explain when and how you became a Christian*
How do you feel about abortion?*
Business/Work Information
Title/Profession*
Company / Organization*
Work Email
Address

Street Address

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CityState / Province

Postal / Zip Code
Work Phone
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?*
Please describe in details some of your greatest strengths and weaknesses*
Are there any personality types / circumstances with which you would have difficulty working?
How do you handle conflict?
What do you feel is essential to ensure that the Board and staff are successful in attaining the goals for Coastal Choices Women's Clinic (CCWC)? *
What experiences, expertise, connections, or resources would you bring to CCWC? *
Please detail your interest in joining this Board*
What type of Board tasks do you prefer?*
Directors of the CCWC Board might take on special projects, in addition to their Board responsibilities, to assist CCWC in our ministry initiatives. Please let us know if you have any specific ministry ideas you would like to propose. *
Have you ever been engaged in any specific fundraising efforts? If so with whom, how, and what was the amount raised? Are you comfortable playing an active role in assisting CCWC with fundraising efforts? *
The CCWC Board will initially have 4 standing committees: (1) Board Building & Governance, (2)Development, (3) Finance & Human Resources, and (4) Program. Please check all that you would be interesting in joining.*

Board Building & GovernanceDevelopmentFinance & Human ResourcesProgram
How much time would you have to dedicate to CCWC(a week, a month, etc…)?*
Please add any additional information you would like us to consider:
CCWC's Board is an exciting and engaged working board. Board members are requested to participate in a minimum of 10 monthly committee meetings. Board members are expected to be timely and present at every meeting with a maximum of three absences from board meetings. Between work within and outside of meetings, hours of commitment would probably vary between 2-3 hours per month. Board members are also encouraged to participate in fundraising and development activities, which include an annual gift to
CCWC that is personally significant and meaningful. Board members are expected to commit to monthly board meetings or at the frequency that the Board establishes.
Will you be able to make this commitment to CCWC?*

YesNoMaybe
Please indicate any concerns here:
After your application has been reviewed you may be asked to interview in order for us to better get to know you. Please have a list of references available upon request. Thank you for your interest.
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.
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Board of Directors Application

Personal Information

Business/Work Information