Shepherd Wellness Community (SWC) Board 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 Home PhoneCell PhoneEmail Current employer/positionWhy are you interested in serving on the SWC Board of Directors?How were you referred to SWC?Please check areas of expertise you can offer to further the mission of SWC: Fundraising Legal Expertise Business Management Program Planning Accounting Social Media Technology Capital Campaign Public Relations Marketing Grant Writing Strategic Planning Medical Education Personnel/Human Resources Quality Management Have you served as a board member for other organizations? Please list organizations and dates served.What other volunteer commitments do you have?A confidential discussion with the SWC board president is required: if you have concerns about conflicts of interest with other organizations, groups or individuals if you have any medical, physical or emotional conditions which could affect your board or committee duties if you have been convicted of a misdemeanor other than minor traffic offences within the last (10) years or if you have been convicted of a felony or released from prison within the last (10) years if you have concerns about information in your background which could be embarassing to you or to SWC should it be made public if you have other relevant information you wish to share with the SWC board president before your application is processed Would you like the SWC board president to call you to confidentially discuss any relevant issues? Yes {all_fields}Attach a resume or other documents to your applicationAccepted file types: doc, docx, pdf, rtf, png, gif, jpg.Print your completed application » Shepherd Wellness Community (SWC) Board 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 Home PhoneCell PhoneEmail Current employer/positionWhy are you interested in serving on the SWC Board of Directors?How were you referred to SWC?Please check areas of expertise you can offer to further the mission of SWC: Fundraising Legal Expertise Business Management Program Planning Accounting Social Media Technology Capital Campaign Public Relations Marketing Grant Writing Strategic Planning Medical Education Personnel/Human Resources Quality Management Have you served as a board member for other organizations? Please list organizations and dates served.What other volunteer commitments do you have?A confidential discussion with the SWC board president is required: if you have concerns about conflicts of interest with other organizations, groups or individuals if you have any medical, physical or emotional conditions which could affect your board or committee duties if you have been convicted of a misdemeanor other than minor traffic offences within the last (10) years or if you have been convicted of a felony or released from prison within the last (10) years if you have concerns about information in your background which could be embarassing to you or to SWC should it be made public if you have other relevant information you wish to share with the SWC board president before your application is processed Would you like the SWC board president to call you to confidentially discuss any relevant issues? Yes {all_fields}Attach a resume or other documents to your applicationAccepted file types: doc, docx, pdf, rtf, png, gif, jpg.Print your completed application »
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