Application For Board Membership
Nominations Committee
9168 T.N. Skiles Road
Ponder, Texas 76259
940-479-2016
940-479-2018 fax
I. Personal & Contact Information
FIRST NAMEM.I.LAST(Will appear in print as written)
STREET ADDRESSCITYSTZIP
MAILING ADDRESS (IF DIFFERENT)CITYSTZIP
HOME TELEPHONEBUSINESS/OTHER TELEPHONEEXT.
FAX NUMBEREMAIL ADDRESS
AFFILIATION (COMPANY OR INSTITUTION)OCCUPATION/TITLE
NAME OF SPOUSE/SIGNIFICANT OTHER (IF ANY)
II. Demographic Information
Gender: FemaleAgeRange: 18-24
Male 25-29
30-34
Ethnicity: African-American 35-39
Hispanic 40-44
Caucasian 45-49
Asian/Pacific Islander 50-54
Native American 55-59
Other______ 60+
III. Community Service & Qualifications
You may use separate sheet of paper if extra space is required to complete each item.
1. Please list all boards you have served on, past and present, and list the terms for each. Include offices you have held and/or committees you have served on.
2. Briefly describe any volunteer activities you have been involved in, past and present.
3. What specific skills and talents do you possess that you feel would be helpful to you in serving on the board of directors?
4. What do you hope to accomplish as a member of the board of directors?
*** Please attach a current résumé to this application if you have one. ***
5. Which of the following have you had experience with?
Check all that apply. Next to each is a space for comments.
Nonprofit Management Business Management
Health Care Management
Social Service Provision
Accounting
Marketing
Volunteer Recruitment
Volunteer Training
Public Speaking
Leadership Training
Equine Management
Special Events
Direct Mail Campaigns
Capital Campaigns
United Way/Federation Campaigns
Donor Solicitation
Board Development/Training
Graphic Arts
Computer Training/Support
Other______
6. Is there anything else you would like to share about yourself that has not already been mentioned (i.e., hobbies, interests, personal history, etc.)?
I certify that the information included in this application is true and correct to the best of my knowledge. I agree to read, understand, and sign the Confidentiality Agreement and the Conflict of Interest Statement. I also certify that I have read the entire application package, understand the expectations and responsibilities of board membership, and promise to fulfill these to the best of my ability if I am elected to the Riding Unlimited Board of Directors.
SIGNATUREDATE
Riding Unlimited, Inc.
Board of Directors
Candidate References
1.Name
Address
City/ST/Zip
Telephone Relationship
2.Name
Address
City/ST/Zip
Telephone Relationship
3.Name
Address
City/ST/Zip
Telephone Relationship
Please return this form with your application and résumé.
Please complete the application and email to
OR print it and mail it to
Riding Unlimited
Ref: Board Member Application
Attn: Dana Barber, President
9168 T. N. Skiles Road
Ponder, Texas 76259
You can also fax it to: 1-940-479-2018
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