AFFA Action Board Application

AFFA Action Board Application
Personal Information
Name*

Last NameFirst Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Demographic Information
Birth Date

MonthDayYear
What is your current gender identity?*

ManWomanTransgender ManTransgender WomanGenderqueer / Gender non-conformingOther
Do you consider yourself to be:*

Heterosexual or straightGay or lesbianBisexual/PansexualQueerOther
Race and Ethnicity (mark all that apply)

Asian / Asian Pacific IslanderBlack / African American / African / Carribean / Afro-LatinxLatinx / Hispanic / ChicanoNative American / IndigenousWhite / EuropeanMultiethnic / MultiracialOther
Business/Work Information
Title/Profession
Company / Organization
What are your current associations and/or club affiliations? (include titles if possible)
Please list any skills, expertise or interests you think may be applicable to AFFA Action board service.
What is your educational background?
What experiences, expertise, connections, or resources would you bring to the AFFA Action Board?
Please share more about your interest in joining the AFFA Action Board.
Thank you for your interest!

After your application has been reviewed you may be asked to interview in order for us to better get to know you. You can expect to hear back from us within 14 days.
Should be Empty: