Name of Prospective Board Member
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First Name
Last Name
Preferred Email Address to receive New Vision communications
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Business Address (use home address if business address doesn't apply)
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different than the above)
Street Address
Street Address Line 2
City
State
Zip Code
Preferred Phone Number
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-
Area Code
Phone Number
Alternate Phone Number
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Area Code
Phone Number
Current Employer Name
Do you have the ability to adjust your daily schedule to participate in board activities during normal business hours?
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Yes
No
Other
In which of these sectors have you worked/been involved? (select as many as apply)
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For-profit
Public/government
Non-profit/charity
Gender
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Please Select
Male
Female
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Date of Birth (MM/DD/YYYY)
Race/Ethnicity
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Previous history of for-profit/non-profit board service (resume/CV upload available at end of app)
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Affiliations (church/temple, civic organizations, other boards on which you currently serve)
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Community connections which may be useful to New Vision:
Religious organizations
Business community
Educational institutions
Media
Political
Philanthropic organizations
Social services
Other
Special skills which may be useful to New Vision:
Fundraising
Personnel/human resources
Finance
Business
Government contracting
Advocacy/politics
Medical profession
Real estate/facilities
Marketing/public relations
Technology
Legal
Insurance
Speak another language
Strategic planning
Event organization
Other
Why are you interested in serving on the New Vision for Independence Board of Directors?
How do you feel you can contribute to New Vision for Independence and/or its Board of Directors?
Please upload your resume (optional)
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Do you consent to New Vision conducting a background check, in accordance with New Vision policies and all applicable laws?
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Please Select
Yes
No
Need clarification
I am interested in joining these committees (committees set annually by Board Chair per needs of organization):
Marketing/fundraising
Research & development
Governance
Audit
Unsure
Other
Who referred you to apply to join New Vision's board?
I agree to fulfill the duties and expectations of a member of the New Vision for Independence Board of Directors as described on newvisionfl.org/board. Type your name to agree with this statement and electronically sign this application.
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