RAN Board Member Application Form

Your Name

First NameLast Name

Email

example@example.com

Cell Phone Number

Format: (000) 000-0000.

Home Phone Number

Format: (000) 000-0000.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contacts

Are you a Veteran? (optional)

Race/Ethnicity (optional)

Languages you speak other than English (optional)

Current Employment Status

Areas of Expertise - In which of the following areas do you have expertise that you can bring to bear in your role as a board member? Check all that apply.

Volunteer History - Do you support other philanthropic causes? What are they and what is the nature of your involvement?

List the most recent board positions you have held. Enter None if you have never held a board position.

In what ways have you interacted with RAN before applying for the board? (Examples: Client, Volunteer, Donor, Event Attendee)

Why is our Mission important to you?

Why do you want to be a RAN Board member?

Every board member is required to disclose potential conflicts of interest. Please describe any possible conflicts of interest if you were to join this board.

RAN Board meetings take place virtually on the third Tuesday of January, April, and July, from 9:00 AM to 10:00 AM Central Time. Additionally, our Annual In-Person Meeting is held on the third Tuesday of October each year. Are you available at these times?

In the last 5 years, have your driving privileges been suspended or revoked?

Have you ever received a hardship license (JDP)?

Have you ever been convicted of a crime?

With your signature on this application as confirmation, do you approve of the following?

Rows	Yes	No
I will attend and actively participate in at least 3 of the 4 quarterly board meetings.
RAN has my permission to run a criminal and driving history background check.
Personal financial contributions to the organization are always welcomed with gratitude, but I understand they are entirely optional.
I will help raise funds for RAN by direct solicitations, selling tickets to events, or other fundraising activities.
I will serve on at least one committee and attend 75% of the committee meetings.

Please provide us with 2 personal references (excluding relatives)

Rows	Name	Email Address	Relationship
Reference #1
Reference #2

Photographic & Volunteer Release

The above information is accurate and correct to the best of my knowledge. RAN is not obligated to provide a replacement opportunity, nor am I obligated to accept the position offered.

In volunteering for RAN, I hereby waive and release Ride Assist Naperville officers, directors, board members, employees, and volunteers from all liability with respect to said transportation and the arrangement for said transportation and agree to hold harmless each of them from claims arising from this service. My signature below indicates my agreement to guidelines set forth by Ride Assist Naperville to volunteers. It also indicates my understanding that volunteering for RAN, I voluntarily assume all risks related to exposure to COVID19. I give permission to the community for the use of my photographs that are taken by staff in order to use for social media.

Volunteer Candidate Signature

Date

Please verify that you are human

Volunteer RAN Board Member Application