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Name Email Address City State Zip Phone - Home Work Cell
Thank you for your interest in becoming a volunteer Board Member. The following questions will help us learn more about you. Please check all applicable items that relate to your experience and/or employment and enter your comments. If you have a resume, please attach a copy to the application.
Personal disability experience Professional experience: disability or rehabilitation Personal Assistant Financial Professional Home Health or other Caregiver Fundraising Legal Professional Nonprofit Management/Operations Disability/Independent Living Services Other
Additional Comments
Why are you interested in serving on the board of Partners in Personal Assistance? Area(s) of expertise/Contribution you feel you can make Other volunteer commitments
In addition to your commitment to attend three-hour monthly board meetings, board service includes participation on at least one committee. Committee work includes a monthly meeting of one to two hours and participation in committee activities that contribute to the overall work of the board. Please check all of the following committees on which you would be willing to serve:
Finance Governance Fundraising Nominating Grant Development Other Other
References: In order to make the best selection of board candidates, we want to know you and your experience as fully as possible. Therefore we conduct a background check on each applicant, including references. Please list two personal references and one work or business related reference that we may contact. Also, please let these references know that we will be in touch. As an addendum to this application, please sign a release of information that we may forward to these references, should they request it.
Personal References: Name Email Address Phone - Home Work Cell Name Email Address Phone - Home Work Cell
Professional/Work-Related Reference Name Email Address Phone - Home Work Cell
Additional comments or personal statement related to your interest in, and expertise related to serving on the board of Partners in Personal Assistance:
Please type your full name below to acknowledge that all of the information provided is both complete and accurate. Full Name
