The Impact Center Advisory Council Application

The Impact Center Advisory Council Application

Thank you for your interest in the Advisory Council, which provides strategic guidance and practical expertise to strengthen programs and expand community contribution at the Impact Center. To apply to as a member, kindly fill out the form below.
Applicant Information
Full Name

First NameMiddle NameLast Name
Preferred Name (if different)
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Preferred Method of Contact
Professional and Organizational Background
Employer / Organization Name
Title / Role
Work Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Type of Business / Organization
Primary Service(s) of Business
Area / Population Served
Board and Committee Experience (Organization / Role / Dates)
Education / Training / Certifications
Awards / Honors
Advisory Interest and Qualifications
Why are you interested in serving on the Impact Center Advisory Council?
What strengths, skills, knowledge, and/or community connections would you bring as an advisor?

Skill Area

Rows	Very Experienced	Some Experience	Little/No Experience
Administration Management
Education / Teaching / Instruction
Facilities / Operations / Safety
Finance / Accounting
Fundraising / Resource Development
Grant Writing / Grant Management
Historic Preservation / Local History
Human Resources / Policy Development
Law / Legal Resources
Marketing / Communications / Media
Nonprofit Experience
Program Planning & Evaluation
Special Events / Community Engagement
Strategic Planning
Website Dev./Technology/Digital Equity
Workforce Development / Business Incubation

Other Area of Expertise
Groups / Organizations / Businesses you could serve as a liaison for
Additional Information
Availability and Participation Preferences
Typical availability for meetings or calls
Preferred method for participating
Candidate Acknowledgment
Candidate Acknowledgment - Signature
Candidate Acknowledgment - Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Candidate Acknowledgment - Printed Name

First NameLast Name
Should be Empty: