Board Member Candidate Profile

Board Member Candidate Profile
Date

MonthDayYear
Date
Personal Information
Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Cell Phone*
Work Phone
Demographic Information
Gender Identity*

MaleFemaleOther
Please mark any that apply to you:*

I am a VeteranI have a disabilityNone
Have you or someone you know experienced addiction?*

YesNoPrefer not to answer
Ethnicity
Nationality
How long have you lived in this community?*
Professional Information
Title/Profession*
Company/Organization Name*
Work Email*
example@example.com
Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Past & Present Memberships (Board committees, task forces in public sectors; i.e., business, civic, community, religious political, professional, recreational or social): *

	Organization Name	Organization Type	Role/Title	Dates of Services (MM/YR-MM/YR)	Skills/Expertise Contribution
1.
2.
3.
4.
5.
6.

What experiences, expertise, connections, or resources would you bring to the Board? *
WHY? Those committed to volunteering in a leadership capacity have an abundance of organizations to choose from. We appreciate your interest in Lifetime Recovery and would like to hear more. Why our organization? Please share your motivation and what about our work has made you want to become a Lifetime Recovery board member.*
Having reviewed our Board Brochure, we are interested in your perspective on the challenges and opportunities that lie ahead for us, and how you envision yourself contributing to solutions that positively impact the individuals we serve*
Time Commitments

Below are the time commitments of board members. Please respond yes to those you are willing and able to do.
A three year time commitment of board service.*
Attend monthly board meetings.*
Serve on one of the following standing committees at the request of the President of the Board: 1) Finance, 2) Development, 3) Program, and 4) Governance*
The Board has four standing committees: (1) Finance, (2)Development, (3) Program, and (4) Governance. Please check all that you would be interested in joining.*

FinanceDevelopmentProgramGovernance
Serve on an ad hoc committee formed by the President of the Board.*
Make a personal and meaningful financial donation each year.*
Promote Lifetime Recovery in the community.*
Recruit and recommend prospective board members, committee members, and others who will assist Lifetime Recovery advancement.*
Thank you for your interest in being part of the Lifetime Recovery family.

After your profile information has been reviewed you may be contacted to schedule a tour and face-to-face meeting. Please feel free to attach your professional resume.

Please certify, with your signature, that the information contained within this form 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.
Signature*

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Board Member Candidate Profile

Personal Information

Demographic Information

Professional Information

Time Commitments