Beverly Burton New Board Member of the Year Award

2019 Louisiana/Mississippi Area Council Awards

This award is given to Board/Council member with less than three years of service on a local governing body.

Deadline for submission is 5 pm on Friday, July 26, 2019.

Contact Shakira Harris, sharris@bgca.org, with any questions about this application form.

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* 1. Please select your state:

Mississippi

Louisiana

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* 2. Nominee Name:

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* 3. Date:

Select month, day, and year

Date

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* 4. Organization Affiliation:

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* 5. Length of Board Membership:

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* 6. Nominee Company & Title:

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* 7. Nominator Name:

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* 8. Nominator Title:

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* 9. Board Participation: Select the person's attendance percentage of regular board meetings.

0 - 20%

20 - 30%

30 - 40%

40 - 50&

50 - 60%

60 - 70%

70 - 80%

80 - 90%

90 - 100%

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* 10. Committee Service: The individual has served on the following committees:

Executive

Board Development

Resource Development/Finance

Human Resources

Marketing & Communication

Property Management

Program

Other (please specify)

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* 11. Leadership: List any offices held by the nominated individual. Include the name of the office and the dates held.

Office 1:

Office 2:

Office 3:

Office 4:

Office 5:

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* 12. Resource Development: The individual is responsible for financial contributions to the Boys & Girls Club at the following level:

$0 - $5,000

$5,000 - $10,000

$10,000 - $25,000

$25,000 - $50,000

$50,000 - $100,000

$100,000 - $200,000

Over $100,000

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* 13. Service to Area Council: The individual has served the Area Council in the following capacity (select all that apply).

Chair

Vice-Chair

Secretary

Treasurer

Liaison

Committee Member

Committee Chair

Other (please specify)

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* 14. BGCA Education & Training: The individual has participated in the following

Board Room Training

Area Council Annual Meeting

Board Leadership Conference

Regional Conference

National Conference

Presenter at Conferences

Board Roundtable Facilitator

Promotion and Marketing of Local Organization and/or BGCA

Other (please specify)

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* 15. Impact on Boys & Girls Club: Please describe the immediate impact of this individual's involvement with your Boys & Girls Club.

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* 16. Community Relations: Please list other service groups or agencies with which the nominee is involved. How have these affiliations helped your Boys & Girls Club?

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* 17. Additional Information: Please list any other pertinent information you would like to share concerning the nominee's Club service, awards received, personal or family information, college attended, etc.

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* 18. Supporting Documentation

Please upload any supporting documentation here.

DOCX, DOC, JPG, GIF, JPEG, PDF, PNG file types only.

Choose File