Board of director

application form

Date Of Application

MM

DD

YYYY

Candidate Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

Preferred Method of Contact:

Current Position & Employer.

Please describe your relevant experience and/or employment.

Please describe the area(s) of expertise/contribution you feel you can make to further the mission of UTInc.:

Please list prior experience serving as a Board member for other non-profit organizations:

What other volunteer commitments do you currently have?

The UTinc. Board of Directors meets on the first Monday of every quarter at 6:00 p.m. EST The meeting generally lasts about two (2) hour. Do you have any standing commitments that create a scheduling conflict for you?

Why are you interested in serving as a Board member for UTInc.?

Please share any other information you feel important for consideration of your application to serve as an UTInc. Board member.

For Board Use

Nominee has had a personal meeting with either an Officer, Director, or other.

Nominee reviewed by the committee.

Nominee proposed to the Board.

Date

MM

DD

YYYY

Board Action

Elected

Rejected

Date

MM

DD

YYYY