Prospective Board of Trustees Candidate Recommendation Form

Candidate Name(Required)

First Last

Address

Street Address Address Line 2 City State ZIP Code

Home Phone(Required)

Home Fax(Required)

Cell Phone(Required)

Email(Required)

Knowledge and expertise helpful to our organization:

Current interest in our organization:

Special Interests:

Education:

Other affiliations with business, civic and community groups, including clubs:

Have you served on other nonprofit boards?

Yes

If yes, what boards and in what capacity?

Known levels of giving:

Does this person have known experience working or socializing in the blind and/or DeafBlind communities? Yes

Yes

If yes, which ones and in what capacity and/or context?

How do you think this person can help The Lighthouse for the Blind, Inc. in fulfilling its mission of creating and enhancing opportunities for independence and self-sufficiency of people who are blind, DeafBlind, and blind with other disabilities?

Please include the reasons why you think this person would be a good board member of our organization. Please highlight personal characteristics and skills that meet our membership criteria at this time:

Please list people whom you suggest might meet, cultivate, and recruit this prospective board member and their relationship to the candidate:

Today's Date

Phone

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