Board Member Application

Date(Required)

Demographic Information

Full name (First, middle, last)(Required)

Familiar name, if applicable

Birth date and month(Required)

Residential Address(Required)

Email Address(Required)

Phone Number(Required)

Preferred Method of Contact(Required)

Work

Residence

Social Media Accounts

Please list any Facebook, Instagram, Twitter/X and LinkedIn accounts

Employment Information

Employer(Required)

Title(Required)

Address(Required)

Email(Required)

Phone(Required)

Type of Business or Organization(Required)

Primary Service(s) and Area/Population Served(Required)

Education

Education/Training/Certificates:(Required)

Involvement

Boards and Committees(Required)

Please list boards and committees that you currently serve on and/or have served on in the past. This may include Business, Civic, Community, Fraternal, Political, Professional, Recreational, Religious and/or Social. Please include the organization, your role/title, and dates of service.

Awards and Recognition

Optional: Have you received any awards or honors that you’d like Brigid’s Path to know about?

Skills, Experience and Interests(Required)

Please select all that apply

List any groups, organizations or businesses that you could serve as a liaison to on behalf of Brigid's Path:(Required)

How do you feel Brigid's Path would benefit from your involvement on its board?(Required)

Please tell us anything else you'd like to share:

Board of Directors Candidate Application

Demographic Information

Employment Information

Education

Involvement

GROW: Rooted in Hope

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