2021 Impact100 Sonoma Grant Committee Registration

2021 Impact100 Sonoma Grant Committee Registration
Your Email Address *
Your First Name *
Your Last Name *
Phone Number
Have you paid your Impact100 Sonoma membership dues for 2021? *

Yes Not yet
Renew Your Membership Here!
What is your Member Status? *

New Member Renewing Member Returning from Hiatus
Have you served on a grant committee before? *

Yes No
If yes, which committee(s)?

Impact Community Anniversary
Are you a NextGen Member?

Yes No
Are you employed?

Yes No
If "Yes", are you working full-time (30 hours or more per week) or part-time?

Full-time Part-time
Conflict of Interest Policy

All Impact100 Sonoma Grant Review Committee members commit to acting with integrity in all of our relationships and in selecting grant recipients through an equitable process. In support of this commitment, we ask for you to disclose affiliations for yourself and your immediate family with nonprofits serving Sonoma Valley. We ask you to provide information on these relationships in our registration form so that we can place you on a committee without conflicts. We also require a committee member to recuse herself from the discussion and/or vote on any topic where a conflict arises.
Are you or your spouse, parent or child affiliated as an officer, director or employee of a Sonoma Valley nonprofit? *

No Yes
If "Yes", please list the nonprofit(s), position(s) held and the name of the affiliated family member. (If there are more than four affiliated organizations, please contact admin@impact100sonoma.org.)
Do you actively serve as a volunteer at a Sonoma Valley nonprofit?

Yes No
If “Yes,” please list the nonprofit(s) for which you volunteer.
Confidentiality Policy

We do not share evaluations or discuss proposals outside of our assigned review committee. We are impartial, and do not lobby others on behalf of an applicant. Except for site visits, we do not engage or privately contact applicants during the grant cycle.
Grants Commitee Registrant Check List:

I have read and accept the aforementioned Conflict of Interest and Confidentiality Policies. I have read and accept the Impact100 Sonoma Statement Of Our Values. I am aware of and agree to the time commitment required to serve on a grants committee.
Impact100 Sonoma Statement Of Our Values

Impact100 Sonoma Grants Calendar
Electronic Signature

Your signature indicates you will observe Impact100 Sonoma's Conflict of Interest and Confidentiality Agreement.
E-Signature--use your finger (for mobile device) or mouse (for computer) to sign in the box below.

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2021 Impact100 Sonoma Grant Committee Registration

Conflict of Interest Policy

Confidentiality Policy

Electronic Signature