2025 Board Readiness Program Application

Preferred First and Last Name

Date of birth

mm/dd/yyyy

What are your preferred gender pronouns? (Choose all that apply)

Please specify:

How would you describe your ethnicity and/ or your racial identity?

Preferred Email Address

Alternate Email Address

Preferred Contact Number

Cell phone is preferred

Brief Bio

City

State

County of Residence

What is the highest level of education you've achieved?

Occupation/ Title

Who is your current employer?

In which county are you employed?

Please select no more than 5 skills you possess:

Please list any leadership roles currently or previously held:

What do you feel are our greatest community needs?

Why are you interested in participating in the Board Readiness Program?

What specifically do you hope to gain from participating in the program?

Please indicate if you can commit to attending all classes and events relevant to the program:

How did you hear about the Board Readiness Program?

Is here any additional information about yourself that you feel is important to share?

Please provide one professional reference:

Please list full name, employer, title, phone number, and email address.

By submitting this application, I certify that all the information provided is true and accurate to the best of my knowledge.

Send me a copy of my responses