Board of Directors Volunteer Application - CAASTLC, Inc. - Services Toward Empowering People,Inc.

Board of Directors Volunteer Application
PERSONAL INFORMATION
Date of Application:
Name:
Address:
City:	State: Zip:
Home Phone:
Business Phone:
Social Security#:
Email:

Why are you interested in serving on the board?

If selected as a board member, how will you support the mission of CAASTLC, Inc. and the Community Action Code of Ethics?

AVAILABILITY TO SERVE

Date you will be able to work:

Will you be available to regularly attend board meetings?

Yes

In addition to board meetings, how many hours per month are you willing to commit to serving CAASTLC, Inc?

What means are you willing to contribute to this organization? (Please check all that apply.)

Financially	Contacts
In-Kind Donation	Sponsorship
Fund Raising	Advocate

EDUCATION AND EMPLOYMENT INFORMATION
Please provide the following information and/or include a current copy of your resume.

Please list your educational background:

Please list your employment history, beginning with your most recent employer:
#1
Organization:
Title:
Employment Dates:

#2
Organization:
Title:
Employment Dates:
#3
Organization:
Title:
Employment Dates:
#4
Organization:
Title:
Employment Dates:

AREAS OF EXPERTISE AND INTEREST
The Agency is striving to ensure that representation on the board and committees is balanced and reflective of the population of St. Louis County, in accordance with funding source requirements. Please indicate what sector of the community you wish to represent:

	Public Sector (Elected Official)
	Private Sector (Business, Social Services, Religion, Law Enforcement, Labor, Education, Civil Rights, Industry, Youth, Elderly, or other major groups with interests in the community served)
	Low-Income Sector (Individual or Neighborhood Representative)

Please indicate your areas of specialty (finance, human resources, fund-raising, etc.):

Please indicate your level of interest in the following committees:

	STRONG	MODERATE	NONE
Finance and Asset Management
Personnel and Equal Opportunity
Planning and Evaluation
Community Relations and Development (Public Relations)
By Laws / Parliamentary
Nominations
Other or any Ad Hoc Committee

COMMUNITY ACTIVITIES
Please list significant community and professional associations (beginning with most recent).

Organization:
Activities:

Organization:
Activities:

Organization:
Activities:

Organization:
Activities:

After you submit this form you will be taken to a page where you
can upload your resum� to us for review.

CAASTLC, Inc. disclaims any warranties regarding the accuracy
or completeness of any information appearing on this website.