NI Board of Directors Application

NeighborImpact Board of Directors/Committee Member Application
*

Board only Committee only Both
Name *

First Name Middle Name Last Name

Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

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 *
Will your service to NeighborImpact create any concerns/conflict with your employer? *

Yes No
Highest level of education attained *

Pre-High School GED/High School Diploma Some College/Associate's Degree Bachelor's Degree Post-Bachelor's Degree
Work Experience (or upload resume below) *
Do you want to attach a Resume? *

Yes No
Resume
How did you become interested in serving on the NeighborImpact Board of Directors? *
Briefly describe other board, committee, volunteer work, life experiences, training, skills, hobbies, special interests and other affiliations that may relate to service at NeighborImpact. *
Please list and briefly explain your current affiliations. *

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.

Board Committees: The Board President appoints membership to committes; and creates and appoints membership on committees or task forces to investigate matters or to advise the Board or any officer on a matter and are intended to be for a single purpose and have limited duration. All directors will be asked to serve on a committee or task force. Meeting and/or teleconference dates and times vary. Please indicate below if you are interesed in serving on any of the following committee or as the Board Liason to the Head Start Policy Council.
Committees:

Finance Committee (meets every month); also acts as Budget Committee and Audit Committee) Early Care and Education Committee (meets every other month) Community Services Committee (meets every other month) Lending, Assets & Housing Committee (meets every other month) Board Liaison to Head Start Policy Council (meeting is third Thursday each month)
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.
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: