Board Member Application | Ability 1st Utah

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ABILITY 1ST UTAH
BOARD OF DIRECTORS NOMINATION FORM

If and when there is a vacancy on the Ability 1st Utah Board of Directors, I would like to be considered. I would be committed to the support and advancement of the organization’s mission.

Full Name*

Type your name as you would like it to appear on Ability 1st Utah’s Materials
Mailing Address*
Preferred mailing address to receive mail from Ability 1st Utah.
Home Phone*
Work Phone
Fax Number
E-mail*
Which best describes you/your areas of interest: check all that apply*
- Person w/a Disability
- Family member w/a Disability Please Circle: Child Sibling Parent Other
- Friend w/a Disability
- Service Provider
- Advocate
- Financial
- Fundraising
- Legal
- Marketing
How much time would you be able to commit to board activities?*
- 4 to 6 hours/month
- 7 to 9 hours/month
- 10 or more hours/month
The board would like its membership to provide cross-disability representation. Are you a person with a disability?*
- Yes
- No
If yes, what is your disability? (This information will remain confidential.)
1. What qualifications/experience/special qualities or skills do you have that would make you an effective member of the board?*
2. Briefly describe your experience with disability and/or disability issues:*
3. Please list any community organizations you have belonged to and/or work with:*
4. Briefly state your interest in serving on the Ability 1st UT Board*
5. Please list any particular characteristics and/or skills you would bring to the Ability 1st Utah Board*
6. The board would like its membership to provide cross-disability representation. Are you a person with a disability?*
- Yes
- No
Signature:*
Nominated by:*
ATTACH RESUME AND/ OR BRIEF BIOGRAPHY*
Max. file size: 8 MB.
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