Pearl Health Foundation Board Member Application
Thank you for your interest in joining Pearl Health Foundation's Board of Directors. Please share your background, skills, and commitment to advancing health equity, autism acceptance, access to care, and support for underserved communities, caregivers, veterans, and military families.
Contact Information
Full Name
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First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
City
*
State
*
Country
*
Professional Background
Occupation / Title
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Organization
*
Professional Background
*
Resume
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Board Experience
Do you have prior board experience?
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Yes
No
Organizations served
Roles held
Years of service
Motivation and Contributions
Why are you interested in joining the board?
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List any skills or expertise you bring to the board (e.g., legal, financial, fundraising, healthcare).
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How would you contribute to the board?
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Availability
Monthly meetings
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Yes
No
Fundraising and outreach
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Yes
No
Availability or constraints
Professional References
Reference Full Name
*
First Name
Middle Name
Last Name
Reference Email
*
example@example.com
Reference Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference Relationship
*
Please Select
Supervisor
Colleague
Client
Mentor
Other
Conflict of Interest
Please identify any potential conflict of interest you may encounter as a Board Member for PHF.
*
If none, enter None. Consider financial, business, family, employment, or other relationships that could affect your board responsibilities.
Signature and Date
Submitting this application does not constitute appointment to the Board of Directors. Appointment is subject to the Foundation’s governing documents and approval process.
Applicant Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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