Board Membership Application

Name*

First NameMiddle NameLast Name

Date*

Date

Driver's License #*

Date of Birth*

Date

SSN

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone

Cell/Other Phone

Work Address*

Work Phone*

Fax Number

Email Address*

example@example.com

1. How did you hear about being a Board Member for EC3?*

2. How long have you worked/lived in the Stephenville area?*

3. Please list employers/companies you have worked for in the past 10 years*

4. Please list all other clubs/organizations you have served with or are currently involved in*

5. What is your professional background?*

For-Profit BusinessGovernmentNonprofit organizationOther

6. What special skills do you have?*

7. What is your level of education?*

8. Please list any addition information you are willing to share with the currently Board Members*

9. Please list any ideas or suggestion you would like to see the EC3 Board address*

Per the EC3 Bylaws Article VI all perspective Board Members are required to pass a Background Check and a Drug Screening due to the nature of our work with children within our community.

Upload a copy of your Drivers License to be submitted with your application for the background check. *

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