Christian Care

Board Application Form

Name

Date

Address

Telephone (home)

work

Other Contact (cell)

Email

Background Information

Occupation

Employer

Employer's Phone

Employer Address

Church Affiliation (name & address)

Work Experience

Volunteer Experience

Education/Major/Degrees

Special Skills, Interests, Hobbies

Board Information

How did you hear about the CC Board?

Why do you wish to serve on the CC Board?

Have you served on other boards?

List:

Are you currently on other board(s)? List:

What areas of expertise can you contribute to CC?

Fundraising
Marketing/Advertising
Financial Management
Building/Grounds
Public Relations
Speakers Bureau

Other:

In what area(s) are you spiritually gifted?

Day/times you are unable to participate in our activities?

Reference Information: (Include name, address and phone number for two people in each category to whom you are not related)

Business:

Personal:

Agreement and Signature:

I will attend board meetings; actively participate in committee meetings and activities designed to provide funding for the organization; and carry out the responsibilities of my job description. I will engage in no activity that would present a conflict of interest with Christian Care. I will hold confidential any information concerning the clients and business of Christian Care, as well as the location of the Domestic Violence Shelter. I affirm that the above information is true and complete to the best of my knowledge, and I understand that this application will be kept in Christian Care's permanent files, and a copy will be made available upon request.

Please type your name to electronically sign this form