LeadUS Mentoring Program 2015-16

Board of Directors Applicant Form
Personal Information
Name

Last NameFirst Name
Date

MonthDayYear
Date
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Birth Date

MonthDayYear
Demographic Information
Gender Identity

Other
Business/Work Information
Title/Profession
Company Organization
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?
What experiences, expertise, connections, or resources would you bring to BAPACSD?
Please detail your interest in joining this Board
Have you ever been engaged in any specific fundraising efforts? If so with whom, how, and what was the amount raised?
The Company Board will initially have 4 projects: (1) Homelessness (2)Education (3) Advocacy, and (4) Youth Voter Registration. Please check all that you would be interesting in joining.

Other
How much time would you have to dedicate to the company (a week, a month, etc…)?
The Board is an exciting and engaged working board. Board members are requested to attend monthly meetings, Between work within and outside of meetings, hours of commitment would probably vary between 3-5 hours per month. Board members are also encouraged to participate in fundraising and development activities. Board members are expected to commit to the role for a minimum of one year. Will you be able to make this commitment to company?
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.
Signature
Date

MonthDayYear
Date
Should be Empty:

Board of Directors Applicant Form

Personal Information

Demographic Information

Business/Work Information