Board of Directors Application Form

Mosaic Board Application

Application Year 2024
Mosaic Mission:

To ensure North Central Wisconsin is the place individuals choose to live and work because differences are embraced; individuals feel connected, valued, and supported; and there is a strong sense of belonging.
Section 1: Your Contact Information
Name*

Last NameFirst Name
Pronouns:
Current Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
Phone Number*

Area CodePhone Number
Section 2: Background Information
Current Employment Status:

Full-timePart-timeSeeking EmploymentRetiredOther
Employer Name (if employed)
Years with Current Employer
Years in Current Field:
Current Occupation:
What is your professional background?
What other volunteer positions have you held?
Section 3: Mission Alignment
If applicable, what ways have you interacted with our organization before applying for the board (examples: committee member, client, donor, event attendee, etc.)?
Why is our mission important to you?
Why do you want to be on the Mosaic board and what skills and attributes will you bring to the organization?
Section 4: Board Commitment
Mosaic Board Meetings occur once a month and last one hour. On occasion, board meetings will have an extended time frame if necessary.

Mosaic Board Meeting time: 3rd Thursday of the Month at 8am. Hybrid available.

Mosaic Board Expectations:

- Attend monthly board meeting (up to 3 excused absences per year)

- Actively participate and advocate for Mosaic and the program offerings

- Believe in the Mission of the organization and reflect the mission in the community

- Contribute to the Organization in one or more of the various forms: time, talent, and/or treasure. Board members are required to serve on at least one committee and become a Mosaic Ally Member (donation of $50 or more.)*

- Participate as appropriate in raising other funds for the Organization

* If the $50 Ally donation will be a financial hardship, please contact us.
I agree to the listed expectations and support the mission of Mosaic of North Central Wisconsin.
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Mosaic Board Application

Mosaic Mission:

Section 1: Your Contact Information

Section 2: Background Information

Section 3: Mission Alignment

Section 4: Board Commitment