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800.373.1043

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

Work

Residence

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, accounting

Personnel, human resources

Administration, management

Nonprofit Experience

Community Service

Policy Development

Program Evaluation

Public Relations, communications

Education, instruction

Special Events

Grant Writing

Fundraising

Outreach, advocacy

OtherOther

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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800.373.1043

1105 S Gilbert Court Iowa City, IA 52240

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Serving Cedar, Des Moines, Henry, Iowa, Johnson, Lee, Van Buren & Washington counties

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