New Board Member Application - Teen Challenge®

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Application for Board Membership and Member Profile

Order Number

Name *

Position/Title: *

Street Address: *

State: *

Phone: *

Religious Affiliation: *

Date of Birth: *

Company Name: *

City: *

Zip Code: *

Email Address: *

Educational Background: *

Work History: *

Hobbies/Interests: *

Experiences as a member of other boards: *

Experiences with other nonprofit associations: *

Experience and assets I can contribute to the board: *

Accounting/Financial

Education Expertise

Event Planning

Fundraising

Legal Expertise

Healthcare/Medical

Management

Marketing

Media Contacts

Networking

Nonprofit Expertise

Public Relations

Public Speaking

Real Estate

Residential Care

Social Work

Strategic Planning

Other

If you selected other, please explain:

Why I am interested in serving as a member of the board: *

What I hope to gain from serving on the board: *

Please include an account of your testimony/salvation experience: *

We ask that all applicants read this one page document called "Ten Basic Responsibilities of Nonprofit Boards."

Please confirm you have read the document *

I have read the above document.

Thank you for your interest in Teen Challenge of the Southeast Region and for giving of your time to complete this important application process!

Information Summary

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Teen Challenge Southeast
15 W 10th St • Columbus, Georgia 31901 USA

EMAIL: info@teenchallenge.cc OFFICE: (706) 596-8731 ADMISSIONS: (855)934-HOPE (4673)

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