Board of Directors Application Question Title * 1. Contact Information Name Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 2. Preferred method of contact? Phone Email Question Title * 3. If employed, please share about your employer Employer Name Your Title Address Address 2 City/Town State/Province ZIP/Postal Code Type of Business or Organization Email Address Phone Number Question Title * 4. Please list boards and committees that you serve on, or have served on. (Business, civic, fraternal, political, professional, recreational, religious, social) Please include: Organization/Committee, Role/Title, and Dates of Service MM/YY - MM/YY for each 1 2 3 4 5 Question Title * 5. Please share any education/training/certificates you have Question Title * 6. Have you received any awards or honors that you'd like to mention? Question Title * 7. Please select any skills, experience, and interests that you would bring to the Board of Directors (Please check all that apply) Lived experience with a disability Fundraising and development skills Legal background Non-profit service or management skills Fiscal management experience Business development experience Media, social media, or public relations experience Other (please specify) Question Title * 8. Please share why you are interested in joining the Access to Independence Board Thank you for applying! Submit Application