Participation Application

Applicant Information

Name (Last, First Middle Initial): / Preferred First Name:
Preferred Mailing Address: / City, State & Zip Code:
Home Phone: / Cell Phone: / Email:

BoardWalk Academy Session Preference (please indicate your first session preference- we will do our best to accommodate your first choice)

Session #1 / May 5th, May 12th, May 19th, May 26th, June 2nd, June 9th
Session #2 / October 6th, October 13th, October 20th, October 27th, November 3rd, November 10th

Experience

Community & Volunteer Involvement

List any community activities or volunteerroles with which you have recently been involved

Organization/Community / Position / Still Involved?

Describe any additional information you feel reflects experience not mentioned above or use this space to share anything about yourself you are particularly proud of:

What community issues are important to you? Select up to 5 areas

  • Animal Rights
/
  • Domestic & Family Violence
/
  • Hunger

  • Arts
/
  • Education
/
  • Immigration

  • At-Risk Children & Youth
/
  • Environmental
/
  • Job Training & Employment

  • Child Abuse & Neglect
/
  • Financial Literacy
/
  • Mental Health

  • Community Improvement
/
  • Health Care
/
  • Senior Services

  • Crime
/
  • HIV/AIDS
/
  • Social Justice

  • Disabilities
/
  • Housing & Emergency Shelter
/
  • Substance Abuse

List what you feel are top 3 critical issues facing the community today, ranking from the highest to the lowest priority:

Respond to the Following Questions

1)Why are you interested in joining BoardWalk Academy?

2)How do you anticipate the BoardWalk Academywill aid or enhance your personal and professional development?

3)Please describe an experience you have had with a nonprofit organization and why it has been meaningful to you.

4)What strengths do you feel you would bring to a non-profit board or committee?

5)What are your goals in terms of community involvement upon completion of the program?

6)Is there anything else you would like the selection committee to know about you?

Please list the names of two personal or professional references

Reference #1:

Name / Relationship
Telephone / Email

Reference #2:

Name / Telephone
Telephone / Email

BoardWalk Academy

Participant Commitment Agreement

Participants are expected to attend ALL six classes in their entirety Session #1 (6-8:30pm – May 5th, May 12th, May 19th, May 26th, June 2nd, and June 9th) OR Session #2 (6-8:30pm- October 6th, October 13th, October 20th, October 27th, November 3rd, November 10th)If you must miss a day, for whatever reason, you are required to notify the facilitators in advance at which point make up work or other arrangements will be discussed. If you must miss more than one class, your graduation certificate will not be awarded and you will be given the opportunity to join a future cohort to complete the program.

I understand the purpose of the BoardWalk Academy and if I am selected, I will devote the time and resources necessary to complete the program. I understand that consistent attendance is a requirement. I will view my acceptance into this program as a commitment to be upheld throughout the year. I further understand that I am expected to commit to utilizing knowledge gained by actively seeking at least one volunteer position on an area nonprofit board or committee.

______

Applicant’s Signature Date

Please return by April 22nd, 2016for Session #1, or September 23rd, 2016 for Session #2 to:

United Way of Dane County

PO Box 7548

2059 Atwood Avenue

Madison, WI 53707-7548

Attn: Kathy Martinson

Email: / Fax: 608-246-4368

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