Printable Board Member Application Form

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OREGON BLACK PIONEERS CORPORATION

 Chair of Board Development

Pioneer Trust Building, Ste 210

117 Commercial Street NE, Salem, OR 97301

martha@oregonblackpioneers.org  503-540-4063

 

Board of Directors Candidate Application

Date ______________________________

 

Name ___________________    First   _____________        MI   ______________Last                        

Residence

Address ___________________________________________________________

Phone ______________________________ E-mail ________________________

Employer        

Name ____________________________________________________________

Your title _________________________________________________________

Address ___________________________________________________________

Phone ______________________________ E-mail ________________________

Type of business or organization ________________________________________

Primary service(s) and area/population served _______________________________

 

Preferred method of contact for this inquiry   (   ) Work        (   ) Residence

 

Please list boards and committees that you serve on, or have served on (business, civic, community, fraternal, political, professional, recreational, religious, social organization).

 

Organization                                   Role/Title                             Dates of Service

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

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Education/Training/Certificates

_______________________________________________________________________

_______________________________________________________________________

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Optional – Have you received any awards or honors that you’d like to mention?

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

How do you feel Oregon Black Pioneers would benefit from your involvement on the Board?

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Skills, experience and interests (Please check all that apply)

___Finance, accounting

___Human resources (Volunteer coord.)

___Office management

___Nonprofit experience

___Community service

___Program development/coordination

___ Public relations, communications

___ Public speaking, presentations

___Special events planning

___Exhibit planning and development

___Grant writing

___Fundraising

___Research- History

___Teaching experience, curriculum  

          development, instruction

___Computer Skills/website maintenance

___Contacts, networking

Other _______________________

Other _______________________

Please list any groups, organizations or businesses that you could serve as a liaison to on behalf of Oregon Black Pioneers.

_______________________________________________________________________

_______________________________________________________________________

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Please tell us anything else you’d like to share.

_______________________________________________________________________

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Thank you very much for applying

Mail to: Oregon Black Pioneers

Pioneer Trust Building, Ste 210

117 Commercial Street NE, Salem, OR 97301

 503-540-4063