Board Member Application

Board Member Application Form
Our Mission: Restored and Revived is a peer-led, family-centered organization committed to serving and finding solutions for those affected by substance use disorder or have been justice-impacted.

Vision: Our vision is to help individuals navigate through the barriers caused by addiction and institutions. We are people who have been there, done that, and want to support others in finding their way with evidence-based coaching and partnerships.
Name*

First NameLast Name
Birthdate*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Gender*

MaleFemaleNot listed above
Race*

Black/African AmericanWhite/CaucasianAmerican Indian/Alaskan NativeHispanic/NativePacific IslanderMulti RacialOtherPrefer not to disclose
Ethnicity*

Hispanic/LatinoNative/HispanicNative AmericanNon-Hispanic/LatinoAsianHawaiian/Pacific IslanderPrefer not to disclose
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company
Department/Position
What is your current experience or involvement with Restored and Revived?
Are you familiar with nonprofit governance? If so, please explain your experience.
What personal skill or strength of yours do you think would benefit our organization?
What other volunteer commitments do you currently have?
Have you served on other nonprofit organization boards? If so, please list them and any offices/positions you hold.
Board members are expected to attend monthly board meetings and participate incommittee work. Can you commit to this level of involvement?

YesNo
Do you have any potential conflicts of interest that might affect your participation on the board? If yes, please explain.
Select your available days

MondaysTuesdaysWednesdaysThursdaysFridaysSaturdaysSundays
Additional notes about your schedule
How many hours per month can you dedicate to board responsibilities, including meetings, events, and preparation?
Specific Skills and Expertise
Please select areas where you have expertise(check all that apply):

Fundraising/DevelopmentMarketing and Public RelationsLegalHuman ResourcesProgram DevelopmentTechnology and ITStrategic PlanningGovernance
Are there specific committees or projects you'd like to participate in? (e.g., fundraising, housing program. governance, program development, community outreach)
Date

MonthDayYear
Date
Signature*

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Board Member Application Form