IWS Board Member Application Form

Board Member Application
Today's Date*

MonthDayYear
Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Profession*
Years in Profession*
Name of Employer*
Employer Website*
Employer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Work E-mail*
Work Phone Number

Area CodePhone 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?

YesNo
When is your birthday? (ex: May 12)
Are you able to meet required board meetings if they are a convenient time and location?

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

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

YesNo
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?*

YesNo
If yes, describe
Diversity
Please indicate all that apply
Race/Ethnicity *

African AmericanAsianCaucasianLatinoNative AmericanOther
Age*

21-3031-4041-5051-6060+
Please indicate all that apply
Gender*

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

Accounting/AuditingAdvertising/MarketingComputers/TechnologyConsultingEducationEngineeringEntreprenuershipFinance/InvestmentFundraising/EventsGoverrmentHuman ResourcesInsuranceLegalManagementOperationsOrganizational DevelopmentPR/ComunicationsReal EstateSales/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

EmailTelephone
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)*

Clear
Should be Empty:

Board Member Application

Background

Additional Information

Diversity

Communication