LAF Board of Directors/Advisory Team 2017 Application

Date *

Date

YYYY

Name *

Name

First Name

Last Name

Mailing Address *

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Personal Phone *

Personal Phone

(###)

###

####

Work Phone

(###)

###

####

Email *

Preferred Method of Contact *

Current Employer

Current Title/Position

Work Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of business or organization (include primary services and area/population served)

Highest Degree Completed

Relevant experience and/or employment *

What is your current level of involvement with LAF? *

How would you like to grow, shape or change LAF to better serve our individuals/families? *

How do you feel LAF wold benefit from your involvement on the Board/Advisory Team? *

What LAF events have you attended in the past? *

What LAF services have you received? Please write N/A if none. *

If you answered other, please describe below:

Please list any previous community board, committee or volunteer experience. *

Why are you interested in serving as a Board Member for the Lowcountry Autism Foundation? *

I am applying to the LAF Board of Directors

The Board of Directors will support the work of The Lowcountry Autism Foundation and provide mission-based leadership and strategic governance. LAF Board Members will consider LAF a philanthropic priority and be accountable for generating revenue that reflect that priority. Board of Directors Responsibilities include, but are not limited to: Attending monthly meetings, alternating from in-person and with conference calls; agree to board terms; complete outside self-managed tasks as needed; Manage, organize and attend LAF events; Be a team player and meet deadlines; Serve on a committee and recruit committee members; Represent LAF to community stakeholders and act as an ambassador for the organization. By checking this box you are agreeing you are capable of meeting these expectations.

I am capable of meeting the expectations of the Board of Directors.

If chosen as a potential board member, I consent to a background check.

I am applying to the LAF Advisory Council

The LAF Advisory Council meets 3 times a year to advise the LAF Board of Directors. The responsibilities of the Advisory Council members are to: -Attend at least 2 meetings per year -Contribute your expertise and thinking to the current and future work of LAF -Be available for four to five telephone calls each year from staff seeking advice -Allow LAF to publish your name as a member of the Advisory Council

I am capable of meeting the expectations of the Advisory Council.

If chosen as a potential advisory council member, I consent to a background check.

Please share any other information you feel is important for consideration of your application to serve on the LAF Board of Directors or Advisory Team

Electronic Signature *

Electronic Signature

By electronically signing your name you attest that the information provided in this form is accurate.

First Name

Last Name

Thank you for your interests in serving the Lowcountry Autism Foundation. To complete the application process, please send a copy of your resume to: callahsu@musc.edu.

Lowcountry Autism Foundation

Board of Directors/Advisory Council

2017 Application