The purpose of this form is to allow nominees that have been selected to be a candidate for the Trailblazers Board of Directors to explain in their own words why they would make an ideal board member.  This information will be reviewed by the entire board.

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* 1. Email

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* 2. Please enter your first and last name.

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* 3. If someone else has already nominated you, please enter their first and last name. If not, leave blank.

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* 4. If you responded to the previous question: What is your relationship to the person who nominated you?

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* 5. Please enter your phone number.

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* 6. Please indicate your age range.

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* 7. Please indicate your gender identity.

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* 8. Please indicate with which of the following you identify. Check all that apply.

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* 9. Where do you primarily reside?

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* 10. Are there any other distinguishing identifiers that might be pertinent to your service on the Trailblazers board? If so, please explain.

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* 11. Please indicate the areas in which you are willing to contribute your skills and knowledge. Select all that apply.

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* 12. Please list any other skills, areas of expertise, professional experience, or volunteer experience that you would be willing to contribute as a Trailblazers board member.

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* 13. Does you have previous or current board experience?

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* 14. If yes, which boards? How many years have you served? What was/is your role? Did/do you serve on any committees?

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* 15. Why do you think you would be a good fit for the Trailblazers board?

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* 16. Are there any potential conflicts that might impede your ability to serve on the Trailblazers board? If so, please explain.

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* 17. Is there anything else we should know? Feel free to use this space to ask questions as well.

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