Board Membership Application

Board Membership Application
Name*

First NameMiddle NameLast Name
Date*

MonthDayYear
Date
Driver's License #*
Date of Birth*

MonthDayYear
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?*

Personnel/ Human resourcesMarketing/Public RelationsFinancesTechnologyLegalBusinessOther
7. What is your level of education?*

Some High SchoolHigh SchoolSome CollegeUndergraduate College DegreeSome Graduate CourseworkGraduate DegreeOther
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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