IWS Board Member Application Form

Board Member Application
Today's Date *

Month Day Year Date Picker Icon
Name *

First Name Last Name
E-mail *
Phone Number *

Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Profession *
Years in Profession *
Name of Employer *
Employer Website *

Employer Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Work E-mail *
Work Phone Number

Area Code Phone Number
How did you hear about IWS? *
Background
How have you been affected by breast cancer? *
Briefly describe other nonprofit organization boards you sat on *
Briefly describe your interest to serving on a board *
Additional Information
What do you do on your free time? *
How many hours can you commit per month? *
When are you able to start a term if selected? *
Number of terms *
What does convenient mean to you? *
What time and day is convenient for you for board meetings? *
Are you interested in serving on a committee as well?

Yes No
When is your birthday?
Are you able to meet required board meetings if they are a convenient time and location?

Yes No
If no, describe why
Do you believe board members are required to make a financial contribution? *

Yes No
If no, describe why
Are there any special requirements? *

Yes No
If yes, describe
What are your strengths in the nonprofit sector i.e. grant writing, public speaking, etc? *
What are your weaknesses in the nonprofit sector, i.e. punctuality, leadership, etc? *
What do you hope you to gain out of serving on the IWS board? *
Describe the relationship and interaction between the board and the Executive Director to you? *
Have you ever been removed from a board, job or institution? *

Yes No
If yes, describe
Diversity
Please indicate all that apply
Race/Ethnicity *

African American Asian Caucasian Latino Native American
Age *

21-30 31-40 41-50 51-60 60+
Please indicate all that apply
Gender *

Male Female
Skillset or Areas Of Interests (Check All That Apply) *

Accounting/Auditing Advertising/Marketing Computers/Technology Consulting Education Engineering Entreprenuership Finance/Investment Fundraising/Events Goverrment Human Resources Insurance Legal Management Operations Organizational Development PR/Comunications Real Estate Sales/Retail
Other
Final words on why you should be chosen?
Communication
Once selection and voting takes place, what's your preferred method of contact?
Preferred method of contact

Email Telephone
I certify that my answers are true and complete to the best of my knowledge. If this application leads to a volunteer assignment, I understand that false or misleading info in my application may result in my release. My signature also gives consent to have a background check completed.
Signature (use your mouse to sign on the screen) *

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Board Member Application

Background

Additional Information

Diversity

Communication