Board Recruitment Application

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* 1. Contact Information

Name *

Company

Address *

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

GETTING TO KNOW YOU

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* 2. What is your occupation?

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* 3. What is your employer's name?

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* 4. What is your title?

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

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

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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?

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* 8. Organization name:

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* 9. Role/Title:

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* 10. Dates of service:

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* 11. Organization name:

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* 12. Role/Title:

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* 13. Dates of service:

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

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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	Accounting, Finance N/A	Accounting, Finance Beginner	Accounting, Finance Intermediate	Accounting, Finance Expert
Administration, Management	Administration, Management N/A	Administration, Management Beginner	Administration, Management Intermediate	Administration, Management Expert
Fundraising	Fundraising N/A	Fundraising Beginner	Fundraising Intermediate	Fundraising Expert
Legal	Legal N/A	Legal Beginner	Legal Intermediate	Legal Expert
Marketing, Design	Marketing, Design N/A	Marketing, Design Beginner	Marketing, Design Intermediate	Marketing, Design Expert
Non-profit experience	Non-profit experience N/A	Non-profit experience Beginner	Non-profit experience Intermediate	Non-profit experience Expert
Personnel, Human Resources	Personnel, Human Resources N/A	Personnel, Human Resources Beginner	Personnel, Human Resources Intermediate	Personnel, Human Resources Expert
Policy Development	Policy Development N/A	Policy Development Beginner	Policy Development Intermediate	Policy Development Expert
Program Evaluation	Program Evaluation N/A	Program Evaluation Beginner	Program Evaluation Intermediate	Program Evaluation Expert
Public Relations, Communications	Public Relations, Communications N/A	Public Relations, Communications Beginner	Public Relations, Communications Intermediate	Public Relations, Communications Expert
Social Media	Social Media N/A	Social Media Beginner	Social Media Intermediate	Social Media Expert
Special Event Planning	Special Event Planning N/A	Special Event Planning Beginner	Special Event Planning Intermediate	Special Event Planning Expert
Technology	Technology N/A	Technology Beginner	Technology Intermediate	Technology Expert
Volunteer Management	Volunteer Management N/A	Volunteer Management Beginner	Volunteer Management Intermediate	Volunteer Management Expert

Other (please specify)

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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	Accounting, Finance N/A	Accounting, Finance Willing	Accounting, Finance Somewhat willing	Accounting, Finance Not willing
Administration, Management	Administration, Management N/A	Administration, Management Willing	Administration, Management Somewhat willing	Administration, Management Not willing
Fundraising	Fundraising N/A	Fundraising Willing	Fundraising Somewhat willing	Fundraising Not willing
Legal	Legal N/A	Legal Willing	Legal Somewhat willing	Legal Not willing
Marketing, Design	Marketing, Design N/A	Marketing, Design Willing	Marketing, Design Somewhat willing	Marketing, Design Not willing
Non-profit experience	Non-profit experience N/A	Non-profit experience Willing	Non-profit experience Somewhat willing	Non-profit experience Not willing
Personnel, Human Resources	Personnel, Human Resources N/A	Personnel, Human Resources Willing	Personnel, Human Resources Somewhat willing	Personnel, Human Resources Not willing
Policy Development	Policy Development N/A	Policy Development Willing	Policy Development Somewhat willing	Policy Development Not willing
Program Evaluation	Program Evaluation N/A	Program Evaluation Willing	Program Evaluation Somewhat willing	Program Evaluation Not willing
Public Relations, Communications	Public Relations, Communications N/A	Public Relations, Communications Willing	Public Relations, Communications Somewhat willing	Public Relations, Communications Not willing
Social Media	Social Media N/A	Social Media Willing	Social Media Somewhat willing	Social Media Not willing
Special Event Planning	Special Event Planning N/A	Special Event Planning Willing	Special Event Planning Somewhat willing	Special Event Planning Not willing
Technology	Technology N/A	Technology Willing	Technology Somewhat willing	Technology Not willing
Volunteer Management	Volunteer Management N/A	Volunteer Management Willing	Volunteer Management Somewhat willing	Volunteer Management Not willing

Other (please specify)

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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.)

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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?

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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.

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* 20. Reference #1

Name

Organization

Relation to you (ex. Former Supervisor)

Phone number

Email address

Preferred method of contact (phone or email)

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* 21. Reference #2

Name

Organization

Relation to you (ex. Former Supervisor)

Phone number

Email address

Preferred method of contact (phone or email)