Board of Directors Application

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Board of Directors Candidate Application

Thank you for your interest in serving with Healthy Start! If you have any questions about the board of directors application process, please contact us at: (407) 228-1479 or info@HealthyStartOrange.org.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Employer Name *

Your job title *

Type of business or organization *

Primary services and area/population served *

Work Address *

Line 1

Line 2

City

State

Zip Code

Country

Preferred method of contact (check all that apply) *

Email Phone Home Address Work Address

Please list boards and committees that you serve on or have served on. Include organization, role/title and approximate dates of service. *

List your education/training/certificates *

Have you received any awards you'd like to mention? *

How do you feel Healthy Start and/or your organization would benefit from your board involvement? *

Skills, experience and interests (select all that apply) *

Finance, accounting Personnel, human resources Administration, management Nonprofit experience Policy development Program evaluation Public relations, communication Special events Grant writing Fundraising Outreach, advocacy Marketing/Social Media Web Design Information Technology

List other skills, experience and interests you'd like to mention. *

List any groups, organizations or businesses that you could serve as a liaison to on behalf of Healthy Start. *

Please tell us anything else you'd like to share. *

Submit