LeadUS Mentoring Program 2015-16

Board Interest Form

Communities In Schools of the Permian Basin
Personal Information
Name

First NameLast Name
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Title/Profession
Company/Organization
Please list your current and past Board experiences:
Why are you interested in joining the Communities In Schools of the Permian Basin Board of Directors?
What are your areas of expertise?

Other
Select any that apply:
If you were referred by a current or previous Communities In Schools of the Permian Basin board member please list their name(s) below:
After your application has been reviewed you may be asked to interview in order for us to better get to know you. Please have a list of references available upon request.

Thank you for your interest.

I certify, by my signature, that the information contained within this application and all supporting documents (i.e., resume, recommendation letters, etc.) is true, accurate, and complete to the best of my knowledge. An electronic signature is accepted.
Signature
Date

MonthDayYear
Date
Please upload your resume:

Cancelof
Should be Empty:

Board Interest Form