Board and Committee Application Board/Committee Application Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Employer*Title*Type of Business or Organization*Primary service(s) and area/population served*Please list boards and committees that you served on, or have served on.*Business, civic, community, fraternal, political, professional, religious, social. Use the (+) sign to add boards or committees OrganizationRole/TitleDate of Service Education/Training/Certificates*Use the (+) sign to add additional awards and honors How do you feel Family Promise of the Mid-Willamette Valley would benefit from your involvement?Skills, Experience and Interests* Finance, Accounting Personnel, Human Resources Administration, Management Non-Profit Experience Community Service Policy Development Program Evaluation Public Relations, Communications, Public Speaking Education, Instruction Special Events Grant Writing Fundraising Outreach, advocacy Property Management Other Please check all that applyWhat time of day is best?* Morning Afternoon Evening How did you learn about volunteer opportunities with Family Promise?*Please List any groups, organizations or businesses that you could serve as a liaison to on behalf of Family Promise*Use the (+) sign to add additional groups, organizations or businesses. References*List two persons not related to you who can speak to your qualifications for this position. If you have previous experience as a volunteer, list one reference from that organization. First Last Phone*Email* Relationship to you*Name* First Last Phone*Email* Relationship to you*THANK YOU!In making this application for volunteer service to Family Promise Mid-Willamette Valley, I express my understanding that all associates of Family Promise MWV, volunteer and employed, are bound by the regulations, policies, procedures and laws that govern Family Promise. I certify that all information provided on this application is true and complete. I give permission to Family Promise staff to contact my listed references and the organizations listed in my experience section as well as complete a criminal background check. I understand that falsification or significant omissions of any information may be considered justification for dismissal if discovered at a later date. I give Family Promise permission to use my photograph, voice or image, with or without my name, both singly and in conjunction with other persons or objects for publicity or recruitment purpose.LIABILITY RELEASE*I hereby release, indemnify and hold harmless Family Promise of the Mid-Willamette Valley from any and all liability in connection with any injury (including any injury caused by negligence), in conjunction with my time volunteering with Family Promise. Yes No PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.