Board Application -

Reference 1 Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Relevant Personal/Business Experience *

A resume may be attached.

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Why Are You Interested in Serving as a Member of the Oregon Family Support Network Board of Director? *

Areas of Expertise/Contributions You Feel You Can Make as a Board Member *

Other Volunteer Commitments *

Please List Three (3) References

Name *

First

Last

Email *

Phone *

Relationship *

Reference 2 Name *

First

Last

Email *

Family Email Member

Phone *

Relationship *

Reference 3 Name *

First

Last

Email *

Phone *

Relationship *

I have received the Board of Director’s information packet. I am aware that the Board member position is an expression of good faith and provides a common ground from which the Board can operate.

By submitting this form I am indicating that I am ready to make a 3-year commitment.

Date