Board Member Application | Ability 1st Utah

Full Name(Required)

Type your name as you would like it to appear on Ability 1st Utah’s materials

Mailing Address(Required)

Preferred mailing address to receive mail from Ability 1st Utah.

Home Phone(Required)

Work Phone

Fax Number

E-mail(Required)

Which best describes you/your areas of interest? Check all that apply.(Required)

Person with a Disability
Family member with a Disability
Friend with a Disability
Service Provider
Advocate
Financial
Fundraising
Legal
Marketing

How much time are you able to commit to Board activities?(Required)

4 to 6 hours/month
7 to 9 hours/month
10 or more hours/month

As a federal mandate, membership of our Board of Directors must be made up of at least 51% individuals with disabilities. Are you a person with a disability?(Required)

Yes
No

If yes, what is your disability? This information will remain confidential.

1. What special qualifications, experience, qualities, or skills do you have that would make you an effective member of the board?(Required)

2. Briefly describe your experience with disability and/or disability issues.(Required)

3. Please list any community organizations you have belonged to or worked with.(Required)

4. Why do you want to serve on the Ability 1st Board of Directors?(Required)

Signature:(Required)

Nominated by:

ATTACH RESUME AND/ OR BRIEF BIOGRAPHY(Required)

Max. file size: 256 MB.