Board Application

Board of Directors Application Form
Date*

MonthDayYear
Date
Name*

First NameLast Name
Email
example@example.com
Phone
Please enter a valid phone number.
Spouse/Domestic Partner
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position/Title
Retired
Type of Business

BOARD STATEMENT OF UNDERSTANDING
As a board member of Circle of Care St. Louis, I am fully committed and dedicated to the mission and have pledged to carry out this mission. I understand that my duties and responsibilities include the following:
1. I am fiscally responsible, with other board members, for this organization. I will ensure the organization’s financial viability and sustainability.
2. I am responsible, along with other board members, for this organization. I am responsible to know and oversee the implementation of policies and programs.
3. I accept the bylaws and operating principles manual and understand that. I am morally responsible for the health and well-being of this organization.
4. I will give what is for me a substantial financial donation. I may give this as a one-time donation each year, or I may pledge to give a certain amount several times during the year.
5. I will actively engage in fundraising for this organization in whatever ways are best suited for me. These may include individual solicitation, undertaking special events, writing mail appeals, and the like. I am making a good-faith agreement to do my best and to raise as much money as I can.
6. I will actively promote Circle of Care St. Louis, encourage and support its staff, and work in concert with the steering council.
7. I will attend board meetings, be available for phone consultation, and serve on at least one Circle of Care St. Louis committee. If I am not able to meet my obligations as a board member, I will offer my resignation.
8. In signing this document, I understand that no quotas are being set, and that no rigid standards of measurement and achievement are being formed. Every board member is making a statement of faith about every other board member. We trust each other to carry out the above agreements to the best of our ability.
Signed*

Clear
Date*

MonthDayYear
Date
Should be Empty:

	Check	Comments/Other
Social Club or Organization
Volunteer Activities
Committees or Task Forces
Board of Directors
Faith Based Councils
Church - Congregation
Other

	Check	Comments/Other
Education (institution and degree)
Business (Small and/or Corporate)
Media/Communications/Marketing
Law Enforcement or Fire Protection
Legal Services, ie: attorney
Financial: banking, planning, insurance
Political or Public Office or Support a candidate
Social Services
Faith based Organization
Advocacy Organization
Human Resources
Real Estate
Technology or IT
Home Health
Nursing
Health Education

	Check	Comments/Other
Special Taskforce
Fundraising or doing an “ask”
Following up with Donors
Seeking out additional Board members
Networking with other professionals
Presenting about the CIRCLE OF CARE, ST. LOUIS to Groups
Participating in Outreach events, i.e.: booths
Assisting with grant writing
Researching & writing articles
Testifying at Legislative Hearings
Writing, emailing or calling Legislators
Other

Board of Directors Application Form

Demographics

Experience, Skills, and Knowledge

Interests and Contributions

BOARD STATEMENT OF UNDERSTANDING