Board Membership Application

Name *

First Name Middle Name Last Name

Date *

Date

Driver's License # *

Date of Birth *

Date

SSN

Address *

Street Address

Street Address Line 2

City State / 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 Business Government Nonprofit organization Other

6. What special skills do you have? *

Personnel/ Human resources Marketing/Public Relations Finances Technology Legal Business Other

7. What is your level of education? *

Some High School High School Some College Undergraduate College Degree Some Graduate Coursework Graduate Degree Other

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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