Board/Council Member of the Year Award

2019 Louisiana/Mississippi Area Council Awards

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. Date:

Select month, day, and year

Date

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* 3. Nominee Name:

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* 4. Club Affiliation:

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* 5. Length of Board Membership:

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* 6. Nominee Company:

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* 7. Nominee Work Title:

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* 8. Nominator Name:

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* 9. Nominator Title:

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* 10. Board Participation: Select the person's attendance percentage ofregular board meetings.

0 - 20%

20 - 30%

30 - 40%

40 - 50&

50 - 60%

60 - 70%

70 - 80%

80 - 90%

90 - 100%

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* 11. Committee Service: The individual has served on the following committees (select all that apply).

Executive

Board Development

Resources Development/Finance

Human Resources

Marketing & Communications

Property Management

Program

Other (please specify)

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* 12. 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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* 13. Resource Development: The individual is responsible for financial contributions to their 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 $200,000

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* 14. 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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* 15. BGCA Education Training: The individuals participated in the following trainings (select all that apply):

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

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

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* 17. 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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* 18. 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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* 19. Supporting Documentation

Please upload any supporting documentation here.

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

Choose File