Board of Directors Nomination

This form is designed for nominations for those who are interested in being considered for a position with the Girl Scouts of Central California South Board of Directors and Board Committees. It is also to be used when referring a potential candidate for one of these positions.

Please note that this form is a nomination only; the Board Development Committee reviews nominations and contacts candidates that may be a good fit for further discussion and interviews, as appropriate.

All candidates should have high standing in their community and an affinity for collaborating with others to achieve a bold new vision for Girl Scouting. An annual contribution of a minimum of $1,000 (give or get) is a requirement for all Board members, which demonstrates that GSCCS is a top philanthropic priority. Candidates who enrich the diversity of the Board -- in all forms -- are highly encouraged to apply.

Please note that, due to conflict of interest regulations, any individual that is currently serving as a staff member or Troop or Service Unit volunteer is ineligible to serve on the Board of Directors or its Committees.

Through this application, I am:

Self-nominating

Referring a potential candidate

If referring a potential candidate, does she/he know of your referral?

Yes

Please select which position(s) the candidate would be interested in:

Board of Directos

Board Development Committee

Board Finance Committee

Board Audit Committee

Board Development (Fundraising) Committee

Board Property Committee

Bylaw Committee

Personal Information

First Name

Last Name

Street Address 1

Street Address 2

City

State / Province

Postal / Zip Code

Country

County

Phone

Birth Date

Occupation

Name of Employer

Title

Business Address

City

State

Zip

Phone

AREAS OF SUBSTATIAL EXPERIENCE

COMPETENCIES SUMMARY

Briefly describe your areas of competencies. Please highlight two areas of greatest strength, particularly with regard to desired qualities described above.

GIRL SCOUTING EXPERIENCE

Where you a Girl Scout as a child?

Yes

Number of years involved as a child:

Have you been involved in Girl Scouting as an adult?

Yes

Volunteer positions and years held:

Awards:

List any current Girl Scouting positions:

SPHERES OF INFLUENCE

Please describe your sphere of influence: Do you have direct contacts in communities, corporations, organizations, foundations, etc. that you would be willing to leverage to benefit GSCCS?

EDUCATION

Degree

College or University

Major or Concentration

Other Education & Training

OTHER BOARD, COMMITTEE, AND VOLUNTEER ACTIVITIES

Please list all Boards for which you are a current member and all volunteer/community work (also list significant past experience).

CONFLICT of INTEREST

Please list any potential conflict of interest that would prohibit you from performing any of the position responsibilities.

Supporting Documentation

Attach a resume or other biographical information summarizing your experience, education and community engagement and/or support.

By checking this box and typing your name below, you are confirming that the information presented on this form is accurate.

Agree

Name

Date

Relationship to Girl Scouts of Central California South (If any):

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