Accepting New Board Member Applications
92 Bowery St., NY 10013
thepascal@mail.com
+1 800 123 456 789
Your name
Your email
Phone number
City
Province
Age range18-2425-3536-5051-6565+
Highest level of education —Please choose an option—Some grade schoolHigh school graduateSome university or collegeUniversity or college graduateSome post-graduatePost-graduate
Occupation
Preferred pronouns
Do you identify as queer? YesNo
Do you identify as trans/gender-fluid/gender queer? YesNo
Do you identify as a survivor of human trafficking? YesNo
What ethnicity do you identify as? Arab / Middle EasternAsianBlackIndigenousHispanic/LatinMixedWhiteOther
Are you a survivor with a visible or invisible disability? YesNo
What type of WomenatthecentrE member would you like be? Community MemberAdvocacy MemberChapter Executive MemberBoard Member
Portfolios that interest you Child WelfareCriminal JusticeEngaging Men & BoysFamily LawGirl ChildHealth & WellnessResearch & EducationSexual ViolenceSheltersWomen & Disabilities
How often would you like to get involved? WeeklyMonthlyEvery 2-3 monthsOther
Would you like to be connected to other members based on similar experiences & interests? Yes pleaseNo thanks
Have you previously engaged in advocacy work?
What do you view as your strengths?
Why do you want to get involved?
Confirm you have read the Confidentiality Agreement. I confirm I have read the Confidentiality Agreement and agree to accept the terms and conditions therein.
