Foundation Board of Directors Application Form

Name(Required)

First Last

Address

Street Address Address Line 2 City State ZIP Code

Home Phone(Required)

Business Phone(Required)

Cell Phone(Required)

Email(Required)

Current Position/Company(Required)

What interests you about serving on the Foundation Board?

What specific strengths and skills do you bring to this board?

Foundation Board Service is highly customizable to individual strengths and interests. What Foundation Board opportunities are you most interested in?

Have you served on other nonprofit boards?

Yes

If yes, which ones and in what capacity?

What other organizations in the community are you a member of?

What is your experience raising funds or in donor relations?

Do you have experience working or socializing in the blind and/or DeafBlind communities?

Yes

If yes, which ones and in what capacity?

How do you think you can help The Lighthouse for the Blind, Inc. in fulfilling its mission of empowering people who are blind, DeafBlind and blind with other disabilities through sustainable employment and transformative services for independence and career advancement?

Do you feel that there is any potential for a conflict of interest as a board member?

Yes

If yes, please explain.

What can we do to ensure that your participation is meaningful, fulfilling and rewarding?

Name

This field is for validation purposes and should be left unchanged.