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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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