United Way LINC Steering Committee Application Application

Transcription

1 United Way LIC Steering Committee Application Application This application will be used to learn about you and your intentions as a potential LIC Steering Committee member. This application will be used internally only; your information will not be shared externally. Please or mail your completed application to: Mailing Address: Emma Crouser United Way of Greater Cincinnati 2400 Reading Road Cincinnati, OH Phone: emma.crouser@uwgc.org The deadline to submit LIC Steering Committee applications is Friday, September 8th. Applicants will be notified of their acceptance status by the following week. We carefully review each application. Visit our website at or our Facebook page at facebook.com/uwgclinc for more information about LIC. 1

2 United Way LIC Steering Committee Application United Way LIC is dedicated to fostering creative thinking and utilizing all facets of a volunteer s skillset. Please attach a resume or a one-page biography so that we can better understand your strengths, passions, areas of interest, skills and abilities. The candidate should have a sincere commitment to be a volunteer leader in the nonprofit community and be willing to accept a volunteer leadership position with the LIC Steering Committee. ame: Home Address: Phone: Prefix/Title First ame Middle ame Last ame Suffix Street City State Zip Check one: Home Mobile Current Employer: Position/Title: Business Address: Business Phone: Street City State Zip The following information is requested to help us better understand our dedicated donors and volunteers. Volunteers are considered for all opportunities without regard to race, color, religion, sex, national origin, age, disability, or marital status. The information that you provide is optional and will not have bearing on acceptance in a leadership volunteer role: Gender Male Female Age Group Date of Birth Ethnicity (check all that apply) White/Caucasian Black/African American Hispanic/Latino/Spanish American Indian/ Alaska ative Asian Indian Chinese Filipino Japanese Korean Vietnamese ative Hawaiian Guamanian or Chamorro Samoan Pacific Islander Other: (mm/dd/yyyy) 2

3 Disability Please identify: Highest Level of Education Completed: High School Associate Bachelors Masters Doctorate Other Degree/ Area of Study: Community Service/ on-profit Experience: ot Applicable Organization Role/Position From/To Staff or Volunteer? Leadership Experience Describe any additional information you feel reflects experience not mentioned above. (training, work, hobbies, etc.) Briefly explain why you are interested in becoming a leader with LIC. How did you learn about LIC? (check all that apply) Co-worker/Workplace Friend/Family BOLD/VLDP Alumni: (ame) United Way Campaign Staff United Way Web site Other United Way Program: Emerging Leader/LIC donor Other: 3

4 United Way LIC Steering Committee To learn more about you and to better determine what you can contribute to board service, please answer the following questions. 1. List three things that you would like to gain from your involvement on a volunteer leadership committee. 2. What strengths (based on your experience and expertise) do you feel you would bring to a volunteer leadership committee? 3. How do you approach leadership when working with diverse groups? Give an example of how you have used your leadership style effectively in the past. Interests Select up to five causes that resonate with you. Rank your choices in numerical order according to your level of interest, 1 being top priority, up to 5 being the lowest priority. Arts/Museum Environmental Mental Health Children/ outh Health Care Recreation Civic/Community Homeless/Emergency Senior Services Disabilities Housing Development Substance Abuse Education Literacy Other: 4

5 Skills Inventory What skills and knowledge can you bring to bring to the committee? Put a check mark in the box that most closely indicates your level of experience in that area. Skills Communications public relations, public speaking, marketing no experience 1-2 years experience 3+ years Experience Diversity Issues Finance auditing, book keeping, budgeting, financial planning Fundraising event planning, grant writing, major gifts, planned giving Human Resources benefits, talent management, personnel Information Technology Organization Development program planning, evaluation, strategic planning Project Management Training & Development Other: Steering Committee meetings will take place every other month. Please list the times and areas of the city that would work best for you to attend these meetings (i.e. I can attend meetings in the morning and afternoon, downtown area works best for me) (specify days of week and times) How many hours a month are willing to commit to this role?: Activities Are you comfortable participating in fundraising activities as a member of the LIC Steering Committee? o es (optional) Comments: As a member of the LIC Steering Committee, you will be requested to contribute to United Way of Greater Cincinnati at or above the LIC donor level of $250 annually. Is this something you re comfortable with? o es (optional) Comments: 5

6 COSET FOR PHOTOGRAPHIC, CIEMATIC, AD/OR VOICE REPRODUCTIO The undersigned hereby consents to the reproduction, publication, and other uses of my photographic or cinematic image, voice and/or property by the United Way of America, United Way of Greater Cincinnati, and any programs of these organizations, however designated. The undersigned further consents to the use of the above-mentioned cinematic image or photographic likeness in any motion picture, television broadcast, advertisement, publication, online mediums, or program at such time and in such places as the above-named organizations, separately or in partnership, and in their individual and joint discretion, shall determine. The undersigned also consents to the irrevocable right to use his/her name (and any fictional name), written copy and photograph for purposes outlined as in the above paragraph. The undersigned further grants the above-mentioned rights without compensation. Print ame: Sign: Phone: Address: Street City State Zip eighborhood Witness: Phone Date: Consent of parent or guardian of minor named above. I affirm that I have legal right to issue such consent: Sign: Witness: 6