The mission of FUSE is to empower families and individuals with disabilities and mental health needs by providing information, training, support and encouragement. We are building our pool of prospective board and committee members, and we would like to consider you. To help us understand your interests and background better, we would appreciate your responses to this questionnaire. We don’t expect you to know everything about us. We simply want to get to know you better, so that we can match you up with a possible position.

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1. Name: (Required.)

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2. Address: (Required.)

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3. Email: (Required.)

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4. Phone: (Required.)

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5. How did you become interested in FUSE?

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6. In case a board or committee position should open up, what roles would you be interested in exploring?

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7. We don’t expect you to be an expert in nonprofit management. If you were to become a board or committee member, what skills would you like to learn through a position?

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8. Tell us about your family. What are your family members’ names, ages, and interests?

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9. Do you or your child have disabilities or mental health needs? If yes, please share any brief info you are comfortable sharing at this point.

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10. What are your favorite hobbies or activities?

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11. Where did you attend high school, college, and/or graduate school, and what did you study?

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12. What is your job title and the name of your company?

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13. What skills do you use in your daily work/home life? (Please select all that apply)

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14. Describe your community affiliations (roles in school, church, sports teams, the arts, service groups, etc.).

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15. What is the best way to contact you, and at what time of the week?

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16. Is there any particular information you’d like to receive about FUSE?

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