Board Member Application

Board Member Application
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Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Business Name and Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Daytime Phone*

Area CodePhone Number
Evening Phone

Area CodePhone Number
E-mail*
Best Way to Contact You*

PhoneEmail
Honors and Awards
Organizational Affiliations (boards and committees on which you currently serve, or have served).
What skills, expertise, connections, etc., do you bring to the board to help accomplish our mission?
Please check areas of interest (check all that apply)

Finance, AccountingPersonnel, Human ResourcesAdministration, ManagementNonprofit ExperienceGovernanceCommunity ServicePolicy DevelopmentProgram EvaluationPublic Relations, CommunicationsHealthcare/HospitalsEducationSpecial EventsGrant WritingFundraisingIndividual Donor MeetingsOutreach, AdvocacyLegalOther
Please list other areas of interests:
How will you cultivate support and involvement? Please keep in mind your interests, talents, networks, and the activities you enjoy.
What do you hope to gain from being a member of the board?
Please list any groups, organizations or businesses where you can serve as a liaison on behalf of KSS.
Is there anything else you would like to share?
How did you hear about this opportunity?
Thank you for your interest in serving on the

Keystone Science School Board of Directors!
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