LeadUS Mentoring Program 2015-16

Board of Directors Applicant Form
Personal Information
Email
example@example.com
Name

Last NameFirst Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Preferred Method of Contact
What is your LinkedIn Profile?
Employment
Title/Profession
Company Organization
Employer Address
Type of Business/Organization
Volunteer Experience

Past and Present Membership: Boards, committees, task forces in the public sector (business, civic, community, religious, political, professional, recreational or social)
Organization 1
Role/Title
Date of Service
Organization 2
Role/Title
Date of Service
Other Volunteer Experiences:
What are your current associations and/or club affiliations? (include titles if possible)
Please mark the skills and expertise you will bring to a nonprofit organization that will strengthen the board and enhance the ability of the organization to deliver on its mission.
What causes are you passionate about?
What is your educational background?
Please describe in details some of your greatest strengths and weaknesses.
What are some of your passions and interest?
What do you feel is essential to ensure that the Board and staff are successful in attaining the goals for a nonprofit organization?
What experiences, expertise, connections, or resources would you bring to a nonprofit organization?
Why do you want to join a board?
What type of Board tasks do you prefer?
There are normally four officers on a board, which officer would you be interested in serving?
Would you be interested in joining any committees? If so, which interest you?
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 nonprofit (a week, a month, etc…)?
Have you ever been convicted, plead guilty or plead no contest to a crime? (If yes, please explain.)
References

Please identify at least three references we can speak with. Please include Name, Relationship and Best Contact (Phone or Email).
Reference 1
Reference 2
Reference 3
Please upload your resume.

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You may upload your letter of recommendations (Optional).

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After your application has been reviewed you will be asked to interview in order for us to better get to know you and provide you with great connections.

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

Employment

Volunteer Experience

References