LeadUS Mentoring Program 2015-16

Board of Directors Applicant Form
Personal Information
Name*

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

Street Address

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Phone Number*
Format: (000) 000-0000.
Can we text you at that number?*

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Birth Date*

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Demographic Information
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Business/Work Information
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Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone
Format: (000) 000-0000.
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*
What do you feel is essential to ensure that the Board and staff are successful in attaining the goals for this organization? *
What experiences, expertise, connections, or resources would you bring to ASID? *
Please detail your interest in joining this Board*
What type of Board tasks do you prefer?*
Please let us know if you have any specific project 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?*
How much time would you have to dedicate to the board (a week, a month, etc…)?*
I understand that as a member of the Board of Directors of Autism Society of Idaho, I have a legal and ethical responsibility to ensure that the organization does the best work possible in pursuit of its goals. I believe in the purpose and the mission of the organization, and I will act responsibly and prudently as its steward. As part of my responsibilities as a board member: I will interpret the organization’s work and values to the community, represent the organization, and act as a spokesperson. In turn, I will interpret our community’s needs and values to the organization, speak out for their interests, and on their behalf, hold the organization accountable. I will attend at least 75 percent of board meetings, committee meetings, and special events. I will actively participate in one or more fundraising activities.*

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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. An electronic signature is accepted.
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Date*

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Board of Directors Applicant Form

Personal Information

Demographic Information

Business/Work Information