Georgia Charter Schools, Inc.
Kennesaw Charter Science & Math Academy
3010 Cobb Parkway, Kennesaw, GA 30152
Application for Nomination to the Board of Directors
Name:
Street Address:
Mailing Address (if different):
City: State: Zip:
Employer: Position:
Home Telephone: Work Telephone: Mobile Telephone:
Preferred E-Mail Address:
Are you the parent of a KCSMA student? Yes No
Are you willing to serve a 3 year term if a parent and a 2 year term if not? Yes No
If no, what length of term are you prepared to serve?
Are you willing to attend Educational Seminars/Board Training? Yes No
Are you willing to attend monthly planning sessions? Yes No
Are you willing to serve on committees for special and ongoing projects during the year? Yes No
Do you object to authorizing the required criminal background check? Yes No
Do you object to submitting to the required fingerprinting? Yes No
Do you object to a confidential credit check if required by the Cobb County School System or the State of Georgia? (this is not routine but may be requested by the district or state) Yes No
Do you have any potential conflict of interest that must be disclosed? If yes, please attach a separate sheet with an explanation of the potential conflict of interest. Yes No
Do you understand the time commitment involved with board service and are you willing and able to devote this amount of time? Yes No
Are you or a member of your immediate family an employee of KCSMA? Yes No
Are you or a member of your immediate family an employee of CCSD? Yes No
Occupation:
Other experience/educational background that may be of service to the board:
Do you have any previous nonprofit board experience? Yes No
If yes, please explain:
Please describe your previous volunteer experience/involvement at KCSMA.
Why are you interested in being a part of the KCSMA Board?
What strengths do you feel you can bring to the KCSMA Board?
How would you describe the role of the KCSMA board and its members?
Describe the interactions of the KCSMA board with the Administration and the PTO.
What are the primary responsibilities of the KCSMA Board?
What do you feel is the greatest challenge facing KCSMA today? What would you suggest as a possible solution?
What do you think the top 3 priorities for the future of KCSMA should be?
Is there anything else you would like for the board development committee to consider with your application?
If elected, when would you be available to begin service as a board member?
Signature Date
By entering your name into the field for signature you are executing an electronic signature.
2