Board Application - Childrens Poverty Alliance

Name*

Phone Number (Work)

Phone Number (Cell)

Address

Email Address (please write it carefully):*

Briefly describe why you would like to join our Board of Directors:*

Your current company & organizational affiliations (names of the companies, organizations and your role(s):*

Which of your skills would you like to utilize on the Board? Check those that apply:

Other skill(s) of yours that you would like to utilize?*

What would you like to get for yourself out of your participation on the Board, e.g., what types of experiences, skills to develop, interests to cultivate for you, etc.?*

Is there anything else you would like to share with us that we might have missed?*

If you join the Board, you agree that you can provide at least 2-4 hours a month in attendance to Board and Committee meetings, and that you do not have any conflict-of-interest in participating on the Board.*

Signature*

Date*

If you are not selected as a member of the Board, or if you decide not to join, would you like to be a volunteer to assist our organization in various ways that match your skills and interests?

Yes

Perharps