Board Member Form
Chrysalis Spectrum Foundation mission is to create a career path for young and middle aged adults with a disability to learn office assistant tasks that will benefit small businesses with completing administrative duties.


We are able to fulfill our mission by having dedicated board members. Our board members meet virtually or in person the second Tuesday every month from 6:00 pm to 7:00 pm. Review and complete the form if interested.
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Email *
First Name *
Middle Initial *
Last Name *
Phone number *
Are you 18 years or older? *
Physical Address *
City *
Zip *
Mailing Address *
City *
State *
Zip *
Have you ever been convicted of a felony? *
Required
If yes, please explain. If no, write N/A *
Board Member Openings *
Which committees are you interested in? *
Required
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