Board Member Candidate Application

Please complete the Board Member Candidate Application to the best of your ability. If a question does not apply to you, or you have no information to provide, please write ‘Not applicable’ or ‘N/A’.

This application is lengthy. If you are unable to complete the application in one sitting, please copy questions to a separate document and answer them at your convenience. You can then return and paste each answer in the appropriate field.

Required
Name prefix: Mr, Mrs, Ms, MS, Dr
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Required
If yes, provide name(s) and explain:
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Required
Select all choices that are applicable to you
Please paste a copy of your TEXT RESUME here
Please list all scholarships, fellowships, honorary degrees, honorary society memberships, and other special recognition for outstanding service or achievements.
Please list any previous board appointments that you have held: Position, dates, and organization.
Please list the name, telephone number and e-mail address of three (3) persons who are willing to serve as references.
List rank, date and type of discharge from active service
Please list any professional licenses you hold, and the state in which the license is registered.

By submitting this application, you agree to submit to a preliminary background check and you affirm that it contains no willful misrepresentation or falsifications and that this information given by you is true and complete to the best of your knowledge and belief.