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First Name
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Last Name
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Email Address
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Home Phone
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Cell Phone
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Street Address
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City
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Zip Code
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Employer / Occupation
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Are you retired?
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Yes
Noi
Current or last position held:
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Business Address
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Business Phone
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Preferred mailing address:
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Home
Buisness
Personal Information
Birthdate (MM/DD)
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Select age range:
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21-30
31-40
41-50
51-60
61-70
71+
How long have you lived in Northern Colorado in years?
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Do you have expertise in any of the following areas?
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Legal expertise
Personnel management
Financial management
Fund/donor development
Public relations
Community relations
Strategic planning
Health/wellness
Prior board experience (Non-MWF)
Which spheres of influence do you have the greatest involvement with?
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Business community
Financial community
Ethnic/minority groups
Media
Government
Healthcare
Nonprofit
Are you a member of any of the following communities?
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Veteran/military servicemember or family member thereof
Healthcare worker or family member thereof
MWF scholarship recipient
MWF patient funds recipient
MWF community grant recipient
Why are you interested in serving on McKee Wellness Foundation's Board of Directors?
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Share with us your professional affiliations:
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What community organizations or activities are you currently involved with, or have you been involved with in the past?
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What are your hobbies and interests?
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What of your overall strengths/passions do you believe would most benefit McKee Wellness Foundation's mission and Board?
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A requirement for service on MWF's Board of Directors is participation in annual giving. Each member is encouraged to give at a level that is personally significant to them. MWF invites leadership from individuals with varying levels of financial means. Do you expect to make an annual commitment to MWF?
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Yes
No
The average monthly time commitment is 6-8 hours per month depending on the activity. Would your schedule allow for you to minimally commit to this amount of time?
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Yes
No
Please rank in order your committee preference (1 being the most preferred):
Governance
Finance
Fund Development
Please provide information for three (non-familial) references, ideally one from a past board you have served, including NAME, EMAIL, PHONE NUMBER, and CONNECTION
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