LeadUS Mentoring Program 2015-16

Junior Board Applicant Form
Personal Information
Name

Last NameFirst Name
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
Ethnicity
Nationality
Business/Work Information
Title/Profession
Company Organization
Email
example@example.com
What are your current associations and/or club affiliations? (include titles if possible)
What experiences, expertise, connections, or resources would you bring to Fellowship House?
Please detail your interest in joining this Board
Please upload a resume below:

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Thank you for your interest in joining the Fellowship House, Inc. Junior Board. Our Junior Board consists of a group of young professionals ages 22-45, who support the goals of Fellowship House, Inc. This group is vital in order to fulfill the Fellowship House mission, through hosting events, volunteerism, and promoting the values of Fellowship House along with the United Way. Members of the Junior Board are required to meet multiple requirements to be considered for and remain in good standing with the board. Members should commit to the following: (select all to agree)
After your application has been reviewed, someone will follow up with you for next steps. 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
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Junior Board Applicant Form

Personal Information

Demographic Information

Business/Work Information