Board of Directors Application Form 2023-2024 Section 1: Your Contact and Demographic Information 1 | 1 Name * First Name Last Name 1|2 Pronouns 1|3 Birth Date * MM DD YYYY Email 1|4 Address * Address 1 Address 2 City State/Province Zip/Postal Code Country 1|5 Race & Ethnicity 1|6 Gender 1|7 Gender Identity Checkbox Cisgender Transgender Gender Nonbinary Other Section 2: Your Background Information 2|1 Current employment status Full Time Part Time Seeking Employment Retired Other 2|2 Employer Name (if employed) 2|3 Years with current employer 2|4 Years in current field 2|5 Current occupation 2|6 What is your professional background? 2|7 What other volunteer positions have you held? 2|8 Please list your degrees (including the school). Section 3: Mission Alignment 3|1 In what ways have you interacted with our organization before applying for the board (examples: committee member, client, donor, event attendee, etc)? 3|2 Why is our mission important to you? 3|3 Why do you want to be on our board? Section 4: Governance 4|1 If you have served on a board before, please provide the name, dates of service and reason for leaving for the three most recent board positions: 4|2 Do we have your permission to contact the organizations above to ask about your board service with them? Yes No Not Applicable 4|3 Each year, every board member is required to disclose any potential conflicts of interest as a board member. Please describe any conflicts of interest you would need to disclose if you joined the board. 4|4 Board meetings are scheduled for the 3rd Tuesday of the 1st month of each quarter from 7:00 to 8:30 PM (actual time varies). Are you available at this time? Yes No 4|5 The minimum expectations for board members are listed below. Please confirm your ability and willingness to meet each. If selected for the board: I will attend and actively participate in at least 10 of the 12 monthly board meetings. I will make a personal annual financial gift at a level that is personally significant. I will raise at least $500 per year for the organization by direct solicitations, selling tickets to events, or other fundraising activities. I will serve on at least one committee and attend at least 85% of the monthly meetings. I will manage at least three relationships on behalf of the organization. 4|6 Interviews will be scheduled with Nominating Committee. Interviews will likely be scheduled in the evening hours between 5:30pm and 8pm. A member of the committee will contact you directly to confirm your interview date and time. Thank you! Please email kulumele@kukumele.org your resume for this application.
