LeadUS Mentoring Program 2015-16

Board of Directors Applicant Form
Personal Information
Name

Last NameFirst Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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.
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.
Past and Present Membership: Boards, committees, task forces in the public sector (business, civic, community, religious, political, professional, recreational or social)
Other Volunteer Experience:
Why? Those who are committed to volunteering in a leadership capacity have an abundance of organizations to choose from. We are most appreciative of your interest in ours and would like to hear more. Why our organization? Please share your motivation and what it is about our work that has drawn us to you.
What excites you about the work of this organization?
Skills/Expertise: Please mark the skills and expertise you will bring to us that will strengthen our board and enhance the ability of our organization to deliver on its mission.
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 historical society (a week, a month, etc…)?
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
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Board of Directors Applicant Form

Personal Information

Business/Work Information