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FACT Oregon Board of Directors Interest Form
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* Indicates required question
Name:
*
Your answer
Email:
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Your answer
Phone:
*
Your answer
Address:
*
Your answer
Personal characteristics: (Check all that apply)
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Under 35
35-50
51-65
Over 65
Male
Female
Gender X
LGTBQ
Other:
Required
Company and role at the organization (or, if self-employed, or working as a primary caregiver, please so indicate)
*
Your answer
Race/ethnic background: (Check all that apply)
*
African-American/Black
Asian
Caucasian
LatinX
Native American
Prefer not to disclose
Other
Required
Disability experience: (Check all that apply)
*
Parent of a child experiencing disability under 26
Family member of a person with a disability
Person with a disability
Educator
Other professional
Other:
Required
Geographic location: (Check one)
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Portland Metro
Coastal
Eastern
Central
Southern
Willamette Valley
Traditionally, the Board of Directors meets the evening of the 4th Thursday of each month at the FACT Oregon office. Are you available for meetings:
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In-person
Remotely/Virtually (via Zoom)
Some in-person, some remotely
Other:
Tell us a little bit about yourself (work, educational background, personal):
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Your answer
What previous volunteer and/or leadership roles have you held (formal/informal)?
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Your answer
What appeals to you about board service as a volunteer activity? What do you hope to get out of your board experience?
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Your answer
What interests you about FACT Oregon specifically?
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Your answer
Have you read FACT Oregon Diversity, Equity and Inclusion statement and do you commit to helping FACT Oregon grow in its practice of diversity, equity and inclusion? To read the statement, visit:
https://www.factoregon.org/diversity-equity-inclusion
.
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Yes
No
How/in what circumstances are you most effective?
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Your answer
What skills, trainings, resources, and expertise do you feel you have to offer?
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Your answer
Having taken a look at the FACT Oregon website, describe how you relate to our core values and our mission of "empowering Oregon families experiencing disability":
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Your answer
Are you comfortable with FACT Oregon's guidelines on board responsibilities? (Can be found here:
https://www.factoregon.org/learn-more-about-joining-our-board-of-directors
)
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Yes
No
Other:
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