Board Member Application

Name *

Email Address *

Phone Number *

Street Address *

City*

State*

Country*

Education *

Position of Interest *

Organization of Interest *

Are you currently involved in another search?
YesNo

Notice Period Required by Current Employer

Employment History

Please enter up to three of your most recent places of employment.

Title *

Employer *

Number of Staff Managed *

Annual Organizational Budget

Reason for Leaving

Voluntary Self-Identification Information

Please select the racial category or categories with which you most closely identify by placing an “X” in the appropriate box. Check as many as apply.
American Indian or Alaska NativeAsianBlack or African AmericanWhiteHispanic/LatinxPrefer not to discloseOtherNative Hawaiian or Other Pacific Islander