Advisory Board Candidate Application

Date: *

MM

DD

YYYY

Name: *

First Name

Last Name

Home Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone: *

(###)

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Employer Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer Phone:

(###)

###

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Preferred Method of Contact: *

Work

Residence

Skills, Experience, and Interests: (Check all that apply)

Finance, accounting

Personnel, human resources

Administration, management

Nonprofit experience

Community service

Policy development

Fundraising

Outreach, advocacy

Program evaluation

Public relations, communications

Education, instruction

Special events

Grant writing

Other