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Board of Directors Application
Home
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
If you are human, leave this field blank.
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?
*
If you are human, leave this field blank.
Submit
