Board of Directors Candidate Application

Name

Address

Email

Phone

Cell Phone

Date of Birth

Employer

Employer's Name

Employer's Address

Employer's Phone

Employer's Email

Your Title

Type of Business or Organization

Primary Service(s) and Area/Population Served

Preferred Method of Contact
WorkResidence

Please list boards and committees that you serve on or have served on (business, civic, community, fraternal, political, professional, recreational, religious, and/or social)

Organization
Role/Title
Dates of Service
Organization
Role/Title
Dates of Service
Organization
Role/Title
Dates of Service

Education/Training/Certificates

How do you feel the Domestic Violence Intervention Program would benefit from your involvement on the Board?

Skills, Experience, and Interests
Finance, accountingPersonnel, human resourcesAdministration, managementNonprofit ExperienceCommunity ServicePolicy DevelopmentProgram EvaluationPublic Relations, communicationsEducation, instructionSpecial EventsGrant WritingFundraisingOutreach, advocacyOther

If other:

Please list any groups, organizations, or businesses that you could serve as a liaison to on behalf of the Domestic Violence Intervention Program

Please tell us why you are interested in working with DVIP

Please tell us anything else you'd like to share

References

Name

Phone

Address

Name

Phone

Address

The DVIP Board of Directors currently meets on the fourth Thursday of the month, 5:30-7:00.

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