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Prospective Board and Committee Member Form
Your Invitation to Effect Change
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Email
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Your email
Name (First and Last)
*
Your answer
Title
*
Your answer
Employer:
*
Your answer
Primary Phone Number
*
Your answer
Alternative Phone Number
Your answer
Address
Your answer
I am interested in being considered for:
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The Easterseals Board
An Easterseals Committee
Other:
What is your time frame for joining the board or committee?
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Now
Within 6 months
Within 1 year
Next year
N/A
Other:
I am interested in being considered for the following committee:
Fundraising: Individual and Corporate
Fundraising: Friend-raising and Stewardship
Finance
Audit
Investment
401K
Policy Review
Governance
How did you learn about this opportunity?
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Your answer
What other boards or committees have or do you serve on? (Please include NAME OF ORGANIZATION, OFFICER POSITION(S), COMMITTEES SERVED & DATES OF SERVICE)
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Your answer
Why are you interested in joining the Easterseals board or serving on a committee?
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Your answer
In what ways do you anticipate having an impact on Easterseals?
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Your answer
Do you or a family member have a disability?
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YES
NO
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