Application for Board Position
Lake County Community Development Corporation (dba Mission West Community Development Partners)
Personal Information
Name
Last Name
First Name
Personal Email
example@example.com
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
Work Phone Number
Birth Date
-
Month
-
Day
Year
Date
Age:
20-30
30-40
50-60
Over 60
Retired
Title/ Profession
Company/ Organization
Work Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your Gender
Are you a veteran?
Are you a member of a federally recognized Indian Tribe? If Yes, Name of Tribe?
What is your Ethnic Background?
Please share some information on your background or attach a short bio.
Why are you interested in participating on this Board of Directors- What do you believe you can best contribute to the board's strength?
What type of Board tasks do you prefer?
Mission West Community Development Partners has 3 standing comittees: (1) Executive, (2) Governance, (3) and Loan. Please check all that you would be interested in joining
Executive
Governance
Loan
MWCDP is an exciting and engaged working board. Board Meetings are typically held on the third Wednesday of the month at 3:00 PM with an occasional special meeting as deemed necessary by the Board. Will you be able to make this committment to the orginatization?
Signature
Date
-
Month
-
Day
Year
Date
Submit
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