Board of Trustees Nomination Form

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* 1. Please enter your contact information.

Name

Email Address

Phone Number

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* 2. Please enter the name and organization of the Board candidate you are recommending (enter "Self" if you are interested in serving on the board yourself).

Name

Organization

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* 3. If you are recommending someone else, is that person aware that you are recommending them?

Yes

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* 4. Statement of Qualifications
Briefly describe the candidate's qualifications for serving on the Philanthropy Southeast Board of Trustees.

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* 5. Governance and/or Committee Experience
Briefly describe the candidate's prior experience with organizational governance, including committee service.

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* 6. Engagement with Philanthropy Southeast
Briefly list any ways in which the candidate has engaged with Philanthropy Southeast – serving on committees and/or task forces, attending events, Hull Fellow, etc., of which you are aware.

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* 7. Biographical Information
If you have the candidate's bio/resume available as an electronic file (Word doc or PDF), please upload it here. Otherwise, please use the question below to provide this information.

PDF, DOC, DOCX file types only.

Choose File

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* 8. If you did not upload a file for the previous question, please include biographical information for the candidate below or provide a link to the candidate's biographical information.

Demographic Information
Philanthropy Southeast strives to have a Board that is representative of the region and the charitable sector and includes a diverse set of voices and perspectives in its decision-making and governance. With this in mind, please answer the questions below regarding your candidate to the best of your ability.

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* 9. Race/Ethnicity

Asian/Asian American

Black/African American

Different Identity

Hispanic/Latinx

Middle Eastern/Arab American

More than one identity

Native American/Alaskan Native

Native Hawaiian/Pacific Islander

White

Prefer not to respond

I don't know

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* 10. Gender Identity

Female

Genderqueer/gender non-conforming

Male

Non-binary

Other identity

I don't know

Prefer not to respond

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* 11. Sexual Orientation

Asexual

Bisexual

Gay or lesbian

Heterosexual

Other

I don't know

Prefer not to respond

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* 12. Disability Status: Does the candidate identify as a member of the disability community?

Yes

I don't know

Prefer not to respond

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* 13. Age Range

20-29

30-39

40-49

50-59

60+

Prefer not to respond

I don't know

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* 14. Does the candidate have any relevant professional licenses/degrees/titles?

Lawyer

CPA

M.D.

Ph.D.

CFRE

None of the above

Other (please specify)

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* 15. What is the candidate's role in their organization?

Trustee

President/CEO/Executive Director

Senior Staff

Board of Trustees Nomination Form

Question Title

* 1. Please enter your contact information.

Question Title

* 2. Please enter the name and organization of the Board candidate you are recommending (enter "Self" if you are interested in serving on the board yourself).

Question Title

* 3. If you are recommending someone else, is that person aware that you are recommending them?

Question Title

* 4. Statement of QualificationsBriefly describe the candidate's qualifications for serving on the Philanthropy Southeast Board of Trustees.

Question Title

* 5. Governance and/or Committee ExperienceBriefly describe the candidate's prior experience with organizational governance, including committee service.

Question Title

* 6. Engagement with Philanthropy SoutheastBriefly list any ways in which the candidate has engaged with Philanthropy Southeast – serving on committees and/or task forces, attending events, Hull Fellow, etc., of which you are aware.

Question Title

* 7. Biographical InformationIf you have the candidate's bio/resume available as an electronic file (Word doc or PDF), please upload it here. Otherwise, please use the question below to provide this information.

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* 8. If you did not upload a file for the previous question, please include biographical information for the candidate below or provide a link to the candidate's biographical information.

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* 9. Race/Ethnicity

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* 10. Gender Identity

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* 11. Sexual Orientation

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* 12. Disability Status: Does the candidate identify as a member of the disability community?

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* 13. Age Range

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* 14. Does the candidate have any relevant professional licenses/degrees/titles?

Question Title

* 15. What is the candidate's role in their organization?

* 4. Statement of Qualifications
Briefly describe the candidate's qualifications for serving on the Philanthropy Southeast Board of Trustees.

* 5. Governance and/or Committee Experience
Briefly describe the candidate's prior experience with organizational governance, including committee service.

* 6. Engagement with Philanthropy Southeast
Briefly list any ways in which the candidate has engaged with Philanthropy Southeast – serving on committees and/or task forces, attending events, Hull Fellow, etc., of which you are aware.

* 7. Biographical Information
If you have the candidate's bio/resume available as an electronic file (Word doc or PDF), please upload it here. Otherwise, please use the question below to provide this information.