Leadership Information Form

Please take a moment to share your contact information and rank the committees you would be most interested in contributing your time and talents to.

Question Title

* 1. Contact Information (used for certification purposes)

Name (First Last)

Pronouns

Phone

Street Address 1

Street Address 2

City

Organization or Company

Job Title or Role

Profession or Discipline

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* 2. Birthday

MM/DD/YYYY

Date

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* 3. Do you identify as a member of the LGBTQIA community?

Yes

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* 4. Race (check all that apply):

White/Caucasian

Black/African American

Asian/Pacific Islander

Hispanic/Latino

Native American

Other (please specify)

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* 5. Living Arrangement:

Renter, Apartment

Renter, Home/Townhome

Renter, Land Trust

Owner, Condo

Owner, Home/Townhome

Owner, Land Trust

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* 6. What aspect of the organization most interests you?

Real Estate Development (Design, Development, and Construction)

Homeownership (Education, Training, and Counseling)

Community Building (Outreach, Engagement, and Programming)

Advocacy (Civic Leadership and Policy Development)

Service (Community Service and Volunteering)

Other (please specify)

Leadership Information Form

Question Title

* 1. Contact Information (used for certification purposes)

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* 2. Birthday

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* 3. Do you identify as a member of the LGBTQIA community?

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* 4. Race (check all that apply):

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* 5. Living Arrangement:

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* 6. What aspect of the organization most interests you?

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* 7. Committee Interest (please rank)

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* 8. Brief Bio for Leadership Directory (send headshot to Kate Holman)