Board Member Application

Complete the following form to begin the Board Member application process. You may save your current work and complete the application at a later time.
I. PERSONAL INFORMATION
Applicant Name*
First Middle Last
Home Address*
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Email*
Enter Email Confirm Email

Email address must be provided to receive a confirmation upon receipt of your application. Allow two weeks from time of submission.

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II. PROFESSIONAL BACKGROUND AND QUALIFICATIONS
Occupation*
Employer's Name*
Employer's Address*
Street Address Address Line 2 City State ZIP Code
Education and Training*
Certificates and Awards*
Other information which may be relevant (Workshops, Professional Memberships, Board Experience)*
III. VOLUNTEER EXPERIENCE
List volunteer experience and include the name of organization, your position and duties.*

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IV. REFERENCES
Please list three references (other than relatives).
First Reference*
First Last
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone*
Email*
Occupation*
Relationship*
Second Reference*
First Last
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone*
Email*
Occupation*
Relationship*
Third Reference*
First Last
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone*
Email*
Occupation*
Relationship*
V. PERSONAL STATEMENT
In a separate document, state why you are interested in serving as a member of the 3to1 Foundation Board of Directors. Include how your background and experience will contribute to the Board. (Two page limit). Upload the document below.
Upload Personal Statement*
Accepted file types: jpg, gif, png, pdf.

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VI. DECLARATION AND ACKNOWLEDGEMENT
By submitting this application to serve on the Board of Directors of the 3to1 Foundation, I understand that the by-laws include certain restrictions and requirements applicable to the directorship of the Board. As a prerequisite to appointment to the Board, I agree to abide by such restrictions and requirements contained in the Foundation’s by-laws as follows:

If I am appointed as a Board Director I shall:
- Become an Annual or Lifetime Member of the 3to1 Foundation
- Attend all regular board meetings unless excused by the Chairman of the Board
- Attend the annual board meeting unless excused by the Chairman of the Board
- Work on at least one 3to1 Foundation committee per year
- Actively solicit sponsors for 3to1 Foundation events
- Actively solicit members for the 3to1 Foundation
- Refrain from speaking on behalf of the 3to1 Foundation unless authorized by the Board
- Make no attempt, for family members or myself, to profit from any 3to1 contract or expenditure
- Avoid any real or perceived conflict of interest between my personal interests and 3to1 Foundation interests
I further understand that should my application to serve on the Board of Directors of the 3to1 Foundation be accepted and I am appointed to the Board, I will be asked to affirm my agreement to the foregoing as part of my oath of office.

I hereby declare that all information contained in this application is true and accurate to the best of my knowledge. I acknowledge that any or all of the content of my application will be kept private and will only be used to determine the status of my application. Should I require additional information regarding the 3to1 Foundation’s Privacy Policy, I will refer the Foundation’s website, www.3to1foundation.org.
Signature*
VII. APPLICATION SUBMISSION
Complete the application by filling out this last section. Submissions are sent to the BOD committee for review.
Contact: Michele Mulholland, 3to1 Foundation Director; michele@3to1foundation.org, 972-764-6524
Full Legal Name*
First Middle Last
Date*
Date Format: MM slash DD slash YYYY
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