APPLICATION FOR APPOINTMENT TO THE BOARD OF DIRECTORS

HANDS OF HOPE RESOURCE CENTER

 

Name:________________________________________________ Home Phone: _____________________

Occupation: ___________________________________________Work Phone: _____________________

Address: ______________________________________________Email address: ____________________

 

Mission:  Our mission is to advocate, educate and promote societal change

for those affected by violence and abuse.

 

YOUR VIEWS ON OUR ORGANIZATION (use reverse side as needed)

What draws you to the board of directors at Hands of Hope Resource Center?

 

 

 

 

YOUR BACKGROUND

What strengths and/or skills could you contribute to our board?  (Please check all that apply)

¨            Accounting/financial

¨            Legal

¨            Fund-raising

¨            Community & public relations

¨            Women’s issues and studies

¨            Management

¨            Planning

¨            Criminal justice link

¨            Knowledge of services/victimization

¨            Public speaking

¨            Team player         

¨            Other (please explain)_________________________

 

On what (if any) other boards have you served?____________________________________________________

 

Charitable or community activities in which you have been or are involved:  (attach additional sheet if needed) __________________________________________________________________________________________

__________________________________________________________________________________________

 

YOUR AVAILABILITY TO SERVE

Would you be willing to commit to a three year term on the Board?                     ¨         Yes       ¨          No

Could you regularly attend board meetings – 3^rd Wednesdays, 5:00 PM?   ¨         Yes      ¨         No       Conflicts: ______________________

How many hours per month, in addition to board meetings, could you serve this organization? ___________

Would you attend a 1-2 hour training session for new board members?  ¨         Yes      ¨         No

Which committees would you be interested in serving on? ________________________________________

 

CONFLICTS OF INTEREST

Would you have a conflict of interest with any of our values or activities?           ¨            Yes           ¨        No

 

REFERENCES (LIST NAMES, ADDRESSES AND PHONE NUMBERS)

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

 

Signature_________________________________________________________Date____________________

 

Return this form to:       Board Chair

Hands of Hope Resource Center

P.O. Box 67

Little Falls, MN  56345