Board Member Application

Name*

First Last

Company Name (if applicable)

Your title (if applicable)

Work phone

work email

Home address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home email*

Preferred personal phone number*

Tell us about your past or current experience with the Coalition.*

If none, simply state so.

Please tell us about your current community board, leadership and/or volunteer commitments*

If none, simply state so.

Please tell us why you interested in serving on the Board of Directors of the Coalition?*

Will you commit to attend regular meetings (either monthly or bi-monthly)?*

Could you commit to attending the Nonprofit Association of the Midlands Board Bootcamp 4-hour workshop?*

Skills, experience and interests (Please check all that apply)*

Any other experience you would like to mention?

Is there anything else you'd like to add?