Mondays Associate Board Member Application

CONTACT

First name:

Last name:

Address:

Apt. #:

City:

State:

Zip:

Home Phone:

Mobile Phone:

E-mail:

EMPLOYMENT

Place of Work/Current Employer:

Position Title:

Industry/Business Type:

VOLUNTEER HISTORY

Please describe any previous volunteer experiences you have had:(Name of organization, type, role, dates of service, etc.)

Please tell us about your qualifcations and why you wish to be on the Mondays Associate Board.

WHAT PRINCIPAL SKILLS/EXPERTISE DO YOU/CAN YOU BRING TO A NONPROFIT BOARD

Checkboxes

Do you have previous Board Experience?

Yes

No

If yes, please describe your experience

Please list any languages you speak other than English:

Please list any special skills you’d like to share with us:

Section

Have you had cancer or a personal connection with a person who had cancer?

Yes

No

If yes, please briefy share your experience with us (types, dates, treatment).

How did you hear about Mondays at Racine?

By signing below, I consent for each of my references to be contacted as a personal or professional reference for me to be provided in confidence to Mondays at Racine. I confirm that I have completed the member profile truthfully. I understand that I may be required to attend an orientation meeting and/or training session. If I choose to volunteer, a background check may be conducted.

Signature:

Date:

CAPTCHA