Request for Board Member Form

Please fax this form to Priscilla Behling at The Volunteer Center at (203) 797-1194.

Organization:
Address:
City:	State:	Zip:
Phone:	Fax:
Email:
Type of agency you would be interested in serving as a board member:

[ ] Health	[ ] Recreation	[ ] Elderly Services	[ ] Civic	[ ] Education
[ ] Faith Based	[ ] Substance Abuse	[ ] Women's Issues	[ ] Mental Health	[ ] Cultural
[ ] Youth	[ ] Environment	[ ] Volunteerism	[ ] Other
Board Member Responsibilities :
Please check all that are appropriate: Credentials Preferred:
[ ] Corporate	[ ] Education	[ ] Homemaker	[ ] Student	[ ] Retiree
[ ] Management	[ ] Trades	[ ] Union	[ ] Media	[ ] Accounting
Skills:
[ ] Marketing	[ ] Sales	[ ] Planning	[ ] Financial	[ ] Public Speaking
Geographic Preference (if any):
What kind of financial commitment do you expect of Board Members?
Who will contact Volunteer?
How soon will contact be made?
Board Meeting Schedule: Day(s) of Week
Time of Day:
Months:
[ ] January	[ ] February	[ ] March	[ ] April	[ ] May
[ ] June	[ ] July	[ ] August	[ ] September	[ ] October
[ ] November	[ ] December
Attach the following information with this completed form. This information enables us to make the most effective match for you. Current agency/Organization brochure Annual Report Current Board List Staff List with Job Description Bylaws and/or Policies and Procedures Any Other Pertinent Information

58 Division Street | Danbury, Connecticut 06810
phone: (203) 797-1154 | fax: (203) 797-1194
volunteers@volunteerdanbury.org