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L'Arche Erie Board Member Application

Page 1 of 3

Name of Prospective Board Member:

Title:

Organization:

Address:

City:

State:

ZIP:

Phone (day):

Phone (evening):

Email:

Source of Referral/Information:

Special Skills/Experience:

Fundraising

Personnel/Human Resources

Finances

Business

Marketing/Public Relations

Technology

Legal

Other

If you selected "other" for Special Skills/Experience, please provide more details:

Professional Background:

For-Profit Business

Non-Profit Organization

Government

Other

If you selected "other" for Professional Background, please provide more details:

Education:

Some High School

High School Graduate

Some College

Undergraduate College Degree

Some Graduate Coursework

Graduate Degree or Higher

Other

If you selected "other" for Education, please provide more details:

Other Affiliations:

Other Board Services:

What, if anything, do you know about L’Arche Erie?

What experience (or understanding) do you have of persons with Intellectual Disabilities?

Please indicate your preferences for Board committee participation in numeric order:

*It is expected that board members are actively involved in at least one committee

Governance

Finance

Development

Strategic Planning

Signature:

Date:

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3745 West 12th Street, Erie, PA 16505

(814) 452-2065

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