NeighborImpact Board of Directors Application

NeighborImpact Board of Directors/Committee Member Application
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Board only Board and Committee Committe
Please contact me in the future when a board seat that matches my qualifications is open. Please never contact me about a board seat.
Name *

First Name Middle Name Last Name

Place of Residence *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Is your mailing address the same as your place of residence?

Yes No

Mailing Address

Street Address
Street Address Line 2
City	State
Zip Code	Country

County/Community *
State *
State
E-mail *
Primary Phone *

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Emergency Contact *

First Name Last Name
Emergency Contact Phone *

Area Code Phone Number
Present Employer *
Occupation *

Commitment

Time: The Board of Directors regularly meets on the second Thursday of each month beginnning at 5:30 pm until 7:30 pm (day and time subject to change). Annual events include: half-to-full day Board of Directors Retreat and annual meeting occurs in December.
Financial: Some grantors require, and donors expect, 100 percent of the Board of Directors to financially contribute to NeighborImpact. All directors are required to financially contribute to NeighborImpact to the extent they are able.

Volunteer/Confidentiality Agreement:

If elected to serve on the Board of Directors or appointed as a committee member at NeighborImpact ("volunteer"), I agree to the following:
1. I will hold all information that I may obtain directly or indirectly concerning clients and/or staff in absolute confidence.
2. I will not solicit my political or religious beliefs to clients and/or staff.
3. My services are donated to NeighborImpact without contemplation of compensation or promise of future employment.
4. I understand that a criminal background and/or credit check may be required depending on the area of my volunteering.
5. I will be punctual and conscientious; conduct myself with dignity, courtesy, and consideration of others and endeavor to make my work professional in quality.
6. I will make every effort to resolve any problems related to my volunteer service with the Board President, Executive Director and/or the Executive Committee.
7. I will make my best effort to fulfill my commitment to NeighborImpact by completing all volunteer assignments that I accept.
8. I understand that NeighborImpact reserves the right to terminate my volunteer status as a result of failure to comply with NeighborImpact's policies; absences without prior notification; unsatisfactory attitude, work, or appearance; or any other circumstance which in the judgement of the Board of Directors, would make my continued service as a volunteer contrary to the best interests of NeighborImpact and in accordance with NeighborImpact policies and bylaws.
9. I understand that it is a violation of NeighborImpact policy to solicit business or act as an agent for outside business.
10. I will refrain from using my volunteer position to seek personal gain through sales of goods or services, or to solicit contributions for organizations other than NeighborImpact, or the pursuit of political activity on behalf of a candidate for public office while volunteering for or representing NeighborImpact.
*

I have read each of the above conditions and agree to be held accountable to them. I acknowledge that typing my name below serves as my electronic signature.
NeighborImpact is frequently contacted by affiliated organizations seeking help in identifying board members with particular skills sets. Would you be willing to allow us to pass your name and contact information along to another organization doing similar and important work in Central Oregon? *

Yes No
Signature *
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NeighborImpact Board of Directors/Committee Member Application

Which, if any, of the following statements apply?

Demographics Information

Commitment

Volunteer/Confidentiality Agreement: