Board of Directors Candidate

Are you interested in being a member of our Board of Directors? Please fill out the form below.

Date Date / MM / DD YYYY
Who can we thank for referring you to apply for our board?
Name Name * First Middle Last
Home Physical Address Home Physical Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Mailing Address (if different from above) Home Mailing Address (if different from above)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone Cell Phone * - ### - ### ####
Home Phone Home Phone - ### - ### ####
Work Phone Work Phone - ### - ### ####
Work Email *
Confirm Work Email *
Personal Email *
Confirm Personal Email *
Preferred method of contact. (Check all that apply.)

Preferred method of contact. (Check all that apply.) Cell Phone Home Phone Work Phone Personal Email Work Email
Employer Information

Please fill out the following information as it pertains to your current employer.
Your Current Employer(s)
Your Title(s)
Employer Mailing Address Employer Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Type of Business or Organization
Primary service(s) and area/population served
Please list boards and committees that you serve on, or have served on. (business, civic, community, fraternal, political, professional, recreational, religious, social)
Organization Role/Title Dates of Service
Education/Training/Certificates *
Optional - Have you received any awards or honors that you'd like to mention?
How do you feel Central Colorado AHEC would benefit from your involvement on the Board? *
Skills, Experience, and Interests (Check all that apply) *

Skills, Experience, and Interests (Check all that apply) Finance, accounting Personnel, human resources Administration, management Nonprofit experience Community Service Public policy development Program evaluation Public relations, communications Education, instruction Legal Special events Grant writing Fundraising Outreach, advocacy Healthcare Discipline Other Other
Please list any groups, organizations or business that you could serve as a liaison to on behalf of CCAHEC
Please tell us anything else you'd like to share.
Please upload your resume.

Attach Files
Required Documents to be Read

Are You Ready To Be A CCAHEC Board Director?
CCAHEC Board Member Position Description and Expectations
BOD Statement of Agreement
Committee Participation Information
Ten Basic Responsibilities of Nonprofit Boards
Please acknowledge you have read the above documents. *

Please acknowledge you have read the above documents. I have read the CCAHEC BOD Position Description, BOD Statement of Agreement, Committee Participation Information, and Ten Basic Responsiblities of Nonprofit Boards
Please acknowledge you understand and agree to committee participation expectations *

Please acknowledge you understand and agree to committee participation expectations I understand that being a Board Director requires regular committee participation outside of the Board meetings. I understand that being a Board Director requires 3 hours a month on average of volunteer time and with particiaption in more than one committee may require up to 6 hours per month.
Thank you for your interest in CCAHEC. We will be in touch with you soon!

Board of Directors Candidate

Board of Directors Candidate

Employer Information

Required Documents to be Read

Thank you for your interest in CCAHEC. We will be in touch with you soon!