Thank you for your interest in serving as a trustee for Headwaters Foundation. Our board plays a critical role in guiding our mission of working side-by-side with Western Montanans to improve the health of our communities. This short form helps us learn more about potential trustees and gather nominations from our community. We appreciate your time and thoughtful responses.

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* 1. Full name of the person completing this form:

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* 2. Your email address:

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* 3. Your phone number:

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* 4. Are you filling this out to nominate yourself, or someone else?

If you are nominating someone to be considered for a board position, you will be automatically be directed to page 2. If you are self-nominating, you will be directed to page 3, and skip page 2.

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