IWS Board Member Application Form

Board Member Application
Today's Date

MonthDayYear
Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Profession
Years in Profession
Name of Employer
Employer Website
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Work E-mail
Work Phone Number

Area CodePhone Number
How did you hear about IWS?
Background
How have you been affected by breast cancer?
Briefly describe other nonprofit organization boards you sat on
Briefly describe your interest to serving on a board
Additional Information
What do you do on your free time?
How many hours can you commit per month?
When are you able to start a term if selected?
Number of terms
What does convenient mean to you?
What time and day is convenient for you for board meetings?
Are you interested in serving on a committee as well?
When is your birthday? (ex: May 12)
Are you able to meet required board meetings if they are a convenient time and location?
If no, describe why
Do you believe board members are required to make a financial contribution?
If no, describe why
Are there any special requirements?
If yes, describe
What are your strengths in the nonprofit sector i.e. grant writing, public speaking, etc?
What are your weaknesses in the nonprofit sector, i.e. punctuality, leadership, etc?
What do you hope you to gain out of serving on the IWS board?
Describe the relationship and interaction between the board and the Executive Director to you?
Have you ever been removed from a board, job or institution?
If yes, describe
Diversity
Please indicate all that apply
Race/Ethnicity

Other
Age
Please indicate all that apply
Gender

Other
Skillset or Areas Of Interests (Check All That Apply)
Other
Final words on why you should be chosen?
Communication
Once selection and voting takes place, what's your preferred method of contact?
Preferred method of contact
I certify that my answers are true and complete to the best of my knowledge. If this application leads to a volunteer assignment, I understand that false or misleading info in my application may result in my release. My signature also gives consent to have a background check completed.
Signature (use your mouse to sign on the screen)
Should be Empty:

Board Member Application

Background

Additional Information

Diversity

Communication