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Board of Directors Application
About NEILS
Board of Directors
Board of Directors Application
Board of Directors Application
Date
*
Full Name
*
Date of Birth
*
Telephone
*
Alternate Telephone
Email
*
Our bylaws require 51% of our Board to be persons with disabilities. Do have a disability?
*
YES
NO
Applicant Address
Street
*
City
*
State
*
Zip Code
*
Employment
Employer
*
Title
*
Employer Telephone
*
How long have you been employed here?
*
Employer Address
Street
*
City
*
State
*
Zip Code
*
Skills and Organizations
Please use the check boxes below to disclose any education or skills you feel you can contribute to our Board:
Accounting
Investing
Fund Raising
Planning
Management
Marketing
Education
Advocacy
Public Relations
Knowledge of Services
Public Speaking
Community Relations
Other
Other
Are you a member of any other organizations in our service area?
*
YES
NO
Organization
City/State
Telephone Number
Organization
City/State
Telephone Number
Organization
City/State
Telephone Number
Other Information
This board holds 12 regular meetings per year (once per month) Will you be able to attend board meetings regularly?
*
YES
NO
Do you have any conflicts with board meetings?
Why are you interested in this organization?
*
Do you have any personal relationship with any past or present employee?
*
YES
NO
If yes, with whom and what is the relationship?
Could you contribute financially to the organization within your means?
*
YES
NO
Could you attend a training session for new board members?
*
YES
NO
How many hours per month, in addition to meetings, could you volunteer at NEILS?
*
Due to the nature of our funding, background checks are necessary upon acceptance of your application. Do you have any objections to having a background check completed?
*
YES
NO
reCAPTCHA
Interested in switching home care providers?
Fill out the form below and someone will be in touch!
Switch Providers
First Name
*
Last Name
*
Email
*
Phone
*
Address
Address
Address
Address
Address
Address
Address
DCN (Medicaid Number)
CAPTCHA - What is the first letter of the last day of the week?
*
Submit
