Contact Information

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* 1. Contact Information

GETTING TO KNOW YOU
What is your occupation? 

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* 2. What is your occupation? 

What is your employer's name?

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* 3. What is your employer's name?

What is your title?

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* 4. What is your title?

What type of business or organization is it?

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* 5. What type of business or organization is it?

Why Dare2tri? How do you identify with our mission?

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* 6. Why Dare2tri? How do you identify with our mission?

Tell us a story, joke, or a memory that helps us understand who you are as a person:

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* 7. Tell us a story, joke, or a memory that helps us understand who you are as a person:

SKILLS & EXPERIENCE
What other boards or committees do you currently serve on or have you served on in the past?
Organization name:

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* 8. Organization name:

Role/Title:

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* 9. Role/Title:

Dates of service:

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* 10. Dates of service:

Organization name:

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* 11. Organization name:

Role/Title:

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* 12. Role/Title:

Dates of service:

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* 13. Dates of service:

If there are additional boards or committees you have/currently serve on, please list:

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* 14. If there are additional boards or committees you have/currently serve on, please list:

Please indicate your skills/experience in the following areas: (Please mark all that apply)

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* 15. Please indicate your skills/experience in the following areas: (Please mark all that apply)

  N/A Beginner Intermediate Expert
Accounting, Finance
Administration, Management
Fundraising 
Legal
Marketing, Design
Non-profit experience
Personnel, Human Resources
Policy Development
Program Evaluation
Public Relations, Communications
Social Media
Special Event Planning
Technology
Volunteer Management
Please indicate your willingness to contribute to the Dare2tri board in the following areas: (Please mark all that apply)

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* 16. Please indicate your willingness to contribute to the Dare2tri board in the following areas: (Please mark all that apply)

  N/A Willing Somewhat willing Not willing
Accounting, Finance
Administration, Management
Fundraising 
Legal
Marketing, Design
Non-profit experience
Personnel, Human Resources
Policy Development
Program Evaluation
Public Relations, Communications
Social Media
Special Event Planning
Technology
Volunteer Management
How/why would you be a valuable member of the Dare2tri board? (Please explain your relevant skills and experience for membership on the board.)

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* 17. How/why would you be a valuable member of the Dare2tri board? (Please explain your relevant skills and experience for membership on the board.)

Time Commitment - In this day and age it’s often difficult to juggle many commitments. How will you make Dare2tri a priority within your day-to-day life?

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* 18. Time Commitment - In this day and age it’s often difficult to juggle many commitments. How will you make Dare2tri a priority within your day-to-day life?

Please list any potential conflicts of interest. Please note, these will not exclude you from potential board membership.

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* 19. Please list any potential conflicts of interest. Please note, these will not exclude you from potential board membership.

REFERENCE SECTION
References should be someone who supervised you in some way. Please don’t list friends and/or family as references.
Reference #1

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* 20. Reference #1

Reference #2

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* 21. Reference #2

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