LeadUS Mentoring Program 2015-16

Envoy Culture Nonprofit Board Member Application

Empowering Communities. Inspiring Change.
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
Place of Birth
Gender Identity

MaleFemaleOther
Nationality
Business/Work Information
Title/Profession
Company Organization
Email
example@example.com
Please list your current and past Board experiences
What are your current associations and/or network affiliations? (include titles if possible or churches if you belong to one)
What is your educational background?
What experiences, expertise, connections, or resources would you bring?
Please detail your interest in joining this Board
Please let us know if you have any specific project ideas you would like to propose.
Please indicate the areas where you feel you can contribute to Envoy Culture. Please check all that you would be interested in joining.

Fundraising/Donor RelationsFinance & Human ResourcesLegal ExpertiseNetworking/Community OutreachProgram DevelopmentMarketing/Public RelationsOther
How much time would you have to dedicate to the company (a week, a month, etc…)?
The board is a dynamic and engaged working group. Members are required to actively participate in the following: At least 4 board conference calls per year 4 quarterly meetings 1 annual in-person meeting A minimum of 11 monthly committee meetings outside of regular board meetings, which may occur via phone or online Board members are expected to attend all meetings promptly, with no more than 2 absences allowed from board meetings annually. The total time commitment, including work within and outside meetings, typically ranges from 3 to 5 hours per month. Additionally, board members are encouraged to support the organization’s fundraising and development efforts, including making an annual contribution that is personally meaningful. Members are also expected to commit to the role for at least one year. In cases where the organization cannot cover expenses, board members collectively share the cost. Are you able to commit to these responsibilities and expectations?

YesNoMaybe
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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Envoy Culture Nonprofit Board Member Application

Personal Information

Demographic Information

Business/Work Information