Board Member Application Form

Board Member Application Form

Please provide a copy of your resume, biography and any other item you feel would be relevant, along with this application.
Contact Information
Name

PrefixFirst NameLast Name
Company
Title
Email
example@example.com
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Office Phone
Please enter a valid phone number.Format: (000) 000-0000.
Website
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Personal Information
Significant Other

First NameLast Name
Relationship
Cell
Please enter a valid phone number.Format: (000) 000-0000.
Please share any personal or lived experiences that have shaped your interest in supporting children and families.
Please share any hobbies, interests, community involvement, or personal passions that help us get to know you better and identify ways you may connect with CASA's mission and activities.
Professional Information
Employer
Title
Work Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Civic and Charitable Affiliations
Civic Organization Memberships
Service Club Memberships
Volunteer Affiliations
Current fiduciary and/or Board Member affiliations
Board Engagement
Why are you interested in serving as a board member for CASA of San Bernardino?
Skills/Expertise Supporting Mission and Strategic Goals
Please expand on how you can leverage the skills and expertise you have selected to support CASA of San Bernardino.
References
Reference 1 Name

First NameMiddle NameLast Name
Reference 1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 1 Email
example@example.com
Reference 2 Name

First NameMiddle NameLast Name
Reference 2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2 Email
example@example.com
Reference 3 Name

First NameMiddle NameLast Name
Reference 3 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3 Email
example@example.com
Certification and Permission
Print Name

First NameMiddle NameLast Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Uploads
Resume

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Biography

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Supporting Materials

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Should be Empty:

Board Member Application Form

Contact Information

Personal Information

Professional Information

Civic and Charitable Affiliations

Board Engagement

References

Certification and Permission

Uploads