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*
Home Phone
Preferred Method of Contact*

Mobile NumberHome NumberEmail
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.*

Public RelationsLegal ExpertiseEvent PlanningSocial MediaFundraisingProfessional Nonprofit ExperienceFinancial ManagementPublic SpeakingHR/ AdministrationMarketingGrant WritingFacilitiesPublic Policy/AdvocacyNonprofit AccountingStrategic PlanningWeb DesignInformation TechnologyReal EstateVolunteer Management
What causes are you passionate about?*

Health and WellnessEducation and LiteracyHuman Services and Social WelfareEnvironment and ConservationArts, Culture, and HumanitiesAnimal WelfareInternational Relief and DevelopmentCivil Rights and AdvocacyReligion and Faith-Based InitiativesCommunity Development
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?*

ChairVice ChairSecretaryTreasurerNot interested in being an officer.
Would you be interested in joining any committees? If so, which interest you?*

FundraisingFinanceProgramCommunications/Social MediaNot interested in being on a committee.
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.*

Cancelof
You may upload your letter of recommendations (Optional).

Cancelof
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

Powered by Jotform SignClear
Date

MonthDayYear
Date
Should be Empty:

Board of Directors Applicant Form

Personal Information

Employment

Volunteer Experience

References