Pennsylvania Association of Senior Centers (PASC) Board Application

Pennsylvania Association of Senior Centers (PASC)

Board of Directors Application
Name*

First NameLast Name
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date*

MonthDayYear
Date
Preferred Email*
example@example.com
Work Address*

Street Address

Street Address Line 2

CityState

Zip Code
Home Address

Street Address

Street Address Line 2

CityState

Zip Code
County where you work*
Your Age*

21-3031-3940-5555-6565-7576+
What is your current Gender Identity?
What is your Sexual Orientation?
Are you a current member of PASC?

YesNo
If yes, PASC member #
How long have you worked in the Aging Network?*
Were you referred by a PASC Board Member? If so, please provide their name.
What are your current associations and/or club affiliations? (Ex. Professional organizations, Rotary Club, Sororities, Fraternities, etc). If you are in a leadership role, include title.
Do you have any experience serving on a Board?

YesNo
Please describe briefly. List any Boards you have participated on and your role.
Why would you like to be considered for service on the PASC Board of Directors?*
What would make you an asset to the PASC Board?*
Board members are asked to serve at least 1 full 2-year term. The PASC Board has 4 quarterly meetings per year: 3 are in person, one is the day before the annual conference. Board members are required to attend all 4 quarterly meetings. Is this something you are able to commit to at this time?*

YesNo
PASC requires each Board member to actively participate in at least 1 committee. Which committee/s are you most interested in?*

MembershipLegislativeProfessional DevelopmentPublic Relations
Committees meet online as needed between Board meetings. Is this something you are able to commit to at this time?

YesNo
Is your employer aware of this application and supportive of your potential Board service?*

YesNo
Board members are asked to make a yearly donation of $100 to PASC. This can be from your agency or from the Board member personally. Are you able to make this donation?*

YesNo
Please upload a copy of your resume.

Cancelof
PLEASE READ CAREFULLY: By signing below I acknowledge that I have read and meet the requirements to serve on the Pennsylvania Association of Senior Centers Board of Directors. I understand that this is an application and that applications are subject to review and approval by the Board. *
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