Ben's Place Services, Inc Board of Directors Application

Board of Directors Applicant Form
Personal Information
Name

Last NameFirst Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Birth Date

MonthDayYear
Demographic Information
Place of Birth
Gender Identity

Other
Ethnicity
Nationality
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.
Please list your current and past Board experiences
What are your current associations and/or club affiliations? (include titles, if possible)
Please list your skills and expertise
What is your educational background?
Please describe in detail some of your greatest strengths and weaknesses.
What do you feel is essential to ensure that the Board and staff are successful in attaining the goals for this organization?
What experiences, expertise, connections, or resources would you bring to Ben's Place Services, Inc.?
Please detail your interest in joining this Board
What type of Board tasks do you prefer?
Please let us know if you have any specific project ideas you would like to propose.
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 Ben's Place Service, Inc. (a week, a month, etc…)?
The Ben's Place Services, Inc. board is an exciting and engaged working board. Board members are required to participate in a minimum of four (4) board conference calls/face-to-face meetings per year. Board members are expected to be timely and present at every meeting with a maximum of one absence from board meetings. Between work within and outside of meetings, hours of commitment would probably vary between 3-5 hours per month. Board members are also encouraged to participate in fundraising and development activities, which include an annual gift to Ben's Place Services, Inc. that is personally significant and meaningful (Suggested: between fundraising/time/personal gift $1,000/annually). Board members are expected to commit to the role for a minimum of one year. Will you be able to make this commitment to the organization?
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
Date
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Board of Directors Applicant Form

Personal Information

Demographic Information

Business/Work Information