Board of Directors Interest Form

INFORMATION ABOUT YOU

The Board of Directors for Meals on Wheels in Terre Haute is made up of professionals from various fields and industries in our community. They all volunteer their time, talent, and skills to help our organization serve this community. If you would like to express your interest in joining our Board, please complete the form below and our Executive Director will schedule a meeting with you.

Together, we CAN deliver!

First name:

Last name:

Street address:

City:

State:

Zip code:

Email Address

Phone number (home or cell):

Phone number (work):

Date of birth (mm/dd/yyyy)

Employer (if retired, former employer):

Special skills/experiences that may help Meals on Wheels:

Previous Board Experience (or relevant experiences):

Are you currently serving on any other Boards?

OTHER INFORMATION

A back ground check will be conducted for all Board Members. The following information will only be used for the background check.

OUR POLICY: It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. Please sign below by printing your full name, thereby giving us permission to run a background check through the Terre Haute Police Department.

Signature:

SECURITY QUESTION: What state are we located in?

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