Board of Directors Candidate

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

Date Date / MM / DD YYYY
Name Name * First Middle Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone * - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Email *
Confirm Email *
Employer Information

Please fill out the following information as it pertains to your current employer.
Your Employer
Your Title
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Type of Business or Organization
Primary service(s) and area/population served
Preferred Method of Contact

Preferred Method of Contact Work Residence
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 in .pdf or .doc format, .docx and other file types will not be accepted.

Attach Files
Required Documents to be Read

CCAHEC BOD Job Description
BOD Statement of Agreement
Ten Basic Responsibilities of Nonprofit Boards
Acknowledge you have read the above documents. *

Acknowledge you have read the above documents. I have read the CCAHEC BOD job description, BOD Statement of Agreement, and Ten Basic Responsiblities of Nonprofit Boards
Thank you for your interest in CCAHEC.

Board of Directors Candidate

Board of Directors Candidate

Employer Information

Required Documents to be Read

Thank you for your interest in CCAHEC.