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Board of Directors Candidate Application (2025-2026)
Date
(Required)
MM slash DD slash YYYY
First Name
(Required)
Middle Initial (If One)
Last Name
(Required)
Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Cell Phone
(Required)
Email
(Required)
Name of Employer
(Required)
Professional Title
(Required)
Employer Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Work Phone
(Required)
Work Email
(Required)
Type of Business/Organization
(Required)
Business
Non-Profit
Government
Academic/School
Health Care
Other
Primary Service(s), Area(s) and Population(s) Served
(Required)
Preferred Method of Contact (Mark All That Apply)
(Required)
Cell Phone
Work Phone
Personal Email
Work Email
Which board are you interested in joining?
(Required)
Agency Board
Foundation Board
Why are you interested in becoming a Board Member for Crisis Services?
(Required)
Describe the work you are currently involved with and how it is relevant to the mission of Crisis Services.
(Required)
Do you have any director experience (professional or personal) with any of Crisis Services' service areas (suicide prevention, domestic/sexual violence, trauma, or mental/behavioral health?
(Required)
YES
NO
If YES, please feel free to elaborate.
Please list organizations or committee that you serve on, or have served on, that would be relevant to the work of Crisis Services, or that you could serve as a liaison to on behalf of Crisis Services. Please indicate ORGANIZATION, ROLE/TITLE, and DATES OF SERVICES.
(Required)
Describe any experience you have had working on or with a not-for-profit board of directors.
(Required)
How do you feel Crisis Services would benefit from your involvement on the Board?
(Required)
Do you know any current/past board members, employees or volunteers of Crisis Services?
(Required)
YES
NO
If YES, please indicate who and how you know them.
Please indicate which of the following skills, experiences, and interests you feel you could contribute to Crisis Services. CHOOSE AT LEAST THREE (no maximum) with which you have direct experience:
(Required)
Finance/Accounting
Human Resources
Labor Relations
Data Analysis & Reporting
Marketing & Social Media
Public Relations and Communications
Non-Profit Administration/Management
Program Evaluation
Quality Assurance/Improvement
LEGAL: General Practice
LEGAL: Labor Law, Union Relations & Negotiations
LEGAL: Non-Profit Governance/Compliance
FUNDRAISING: Major Gifts
FUNDRAISING: Endowment Building
FUNDRAISING: Capital Campaigns
FUNDRAISING: Event Planning
FUNDRAISING: Grant Writing
Victims’ Services
Mental/Behavioral Health
Health Care & Wellness
Please indicate any of the following groups with which you identify (if any):
Black/African-American
Indigenous/Native American
Latino/a/e
Asian/Pacific Islander
Veteran/Current Military
Disabled
LGBTQIA+
New Immigrant/Refugee
Additional Comments: Please tell us anything else you’d like to share. Thank you for your interest in Crisis Services!
