AdNet Committee Interest Form

1

Full Name

First Name

Last Name

2

Name of Community Foundation

3

Email

example@example.com

4

What committee(s) are you interested on serving on?Select all that apply

Programs - Peer Exchange

Membership & Communications

Programs - Mentorship

Programs - Conference

5

Where are you located?

Midwest (IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, WI)

Northeast (CT, DC, DE, MA, ME, MD, NH, NJ, NY, PA, RI, VT)

Southeast (AL, AR, FL, GA, KY, LA, MS, NC, SC, TN, VA, WV)

Southwest (AZ, NM, OK, TX)

West (AK, CA, CO, HI, ID, MT, NV, OR, UT, WA, WY)

7

Your professional credentials and/or certificationsSelect all that apply

Chartered Advisor in Philanthropy® (CAP)

Certified Fundraising Executive (CFRE)

Advanced Certified Fundraising Executive (ACFRE)

Juris Doctor (JD)

21/64 Certification

Other

8

Community Foundation's Asset Size

9

What influenced you to want to be a part of a committee?

10

Any experience or background information that would be helpful in determining the right committee placement?

11

What do you hope to take away from this experience?