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Application for Board Position with Lungs at Work
Thank you for your interest in joining the Lungs at Work Board of Directors! Use this form to provide useful information about yourself to ensure the best match between you and Lungs at Work. The following information will be shared only with existing Board Members of Lungs at Work.
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* Indicates required question
Full Name
*
Your answer
Email Address
*
Your answer
Telephone Number
*
Best number on which to reach you.
Your answer
Briefly describe why you would like to join our Board of Directors:
*
Your answer
Your non-profit organizational affiliations. If you have none, please indicate not applicable.
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Names of organizations and your role(s)
Your answer
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Expert
Modest
Apprentice
None
Financial Management
Grants - Federal or Other (application/management)
Analytics (data, metrics)
Strategy, Business Development
Non-profit Governance
Marketing/Communications/PR
Fundraising
Technology
Human Resources
Expert
Modest
Apprentice
None
Financial Management
Grants - Federal or Other (application/management)
Analytics (data, metrics)
Strategy, Business Development
Non-profit Governance
Marketing/Communications/PR
Fundraising
Technology
Human Resources
Which intellectual capital would you bring to the Board?
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Skills and in-depth experience
Developing/learning
Aware of, but no experience
Non-profit Program Design
Business Development
Leadership Development
Coaching
Human Development
Skills and in-depth experience
Developing/learning
Aware of, but no experience
Non-profit Program Design
Business Development
Leadership Development
Coaching
Human Development
Which social and relationship capital would you bring to the Board?
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Well connected
Developing/learning
None
Fundraising/Access to Resources
National Field/Industry Network
US Region
Other Geographic Region
Well connected
Developing/learning
None
Fundraising/Access to Resources
National Field/Industry Network
US Region
Other Geographic Region
What political and reputational capital would you bring to the Board?
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Strong/well-known
Some capital
None
Corporate Sector
Non-profit Sector
Government Sector (Federal/State/Local)
Philanthropy
Respected Community Leader
Strong/well-known
Some capital
None
Corporate Sector
Non-profit Sector
Government Sector (Federal/State/Local)
Philanthropy
Respected Community Leader
Which qualities would you bring to the Board?
*
Expert
Developing/learning
None
Availability/capacity to work
Facilitator
Team builder/bridger
Strategic with follow through
Mission passion
Financial contribution
Visionary/big picture thinker
Strong communicator
Expert
Developing/learning
None
Availability/capacity to work
Facilitator
Team builder/bridger
Strategic with follow through
Mission passion
Financial contribution
Visionary/big picture thinker
Strong communicator
Personal demographics: Gender
*
Choose
Male
Female
Prefer not to say
Personal demographics: Age
*
Choose
Age 18-29
Age 30-39
Age 40-49
Age 50-59
Age 60+
Prefer not to say
What would you like to get for yourself out of your participation on the Board?
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What types of experiences, skills to develop, interests to cultivate for you, etc.?
Your answer
How interested are you in taking a leadership role within the first year?
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Committee Chair, Treasurer, Secretary, Chair, or Vice-chair
Not Very
1
2
3
4
5
Very
If you join the Board, do you agree that you can provide at least 8-10 hours per quarter in attendance to Board meetings and doing the work of the board?
*
Choose
Yes
No
Maybe
Do you have any conflicts of interest that would need to be considered in your role of the Board?
*
Choose
Yes
No
Maybe
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