PPA Board Online Form

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