Goshen HELP Committee Member Application

Goshen HELP Committee Member Application
1933 Main Street, Torrington WY 82240 - 307-532-0269

Serving Carbon, Crook, Goshen, Niobrara, Washakie, & Weston Counties as of October 1st, 2020.
Date*

MonthDayYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Which Committee are you interested in serving?

GovernanceFinancialPersonnelProgrammaticCarbon County LocalCrook County LocalGoshen County LocalNiobrara County LocalWashakie County LocalWeston County Local
Do you forsee any conflict of information between serving on a committee and working for your employer? If yes, please explain.
List any previous experience you may have with serving on boards or committees. Please include name of the organization, your role and responsibility, and dates.
Please list any training you may have received that you believe would benefit Goshen HELP.
Should be Empty: