New Board Member Form

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General Information

First Name

Last Name

Street Address

Include Apartment or Unit Number separated by a comma

City

Country

State

Postal Code

Date of Birth

Phone

Languages Spoken:

If "Other," please describe:

Gender (check all that apply):

FemaleMaleNon-binary / third genderPrefer not to sayPrefer to self-describeTransgender

Pronoun Used

If "other," please share here:

Are you associated with an organization/company/group?

If you currently work, please list your place of work below.

Please share why you are interested in serving as a Board Member with CAN.

Involvement Interest and Availability

Are you interested in volunteering with/serving CAN in addition to participating in the quarterly board meetings?

I am available for weekly volunteer opportunitiesI can volunteer every once in a whileI cannot commit more time at the momentOther

If "Other," please describe.

What are skills or interests you would like to share with CAN?

AccountingEvaluationsLawManagementMarketingMedicalSalesTeachingOther

If "Other," please describe.

What types of opportunities are you interested in?

Working with children and youthFood/Resource assistanceCommunity buildingParticipating in a committee (Finance, Fundraising, etc.)Large group and/or one-time volunteer opportunities (i.e. painting walls, cleaning community centers, gardening, community clean-up campaigns, etc.)Other

If "Other," please describe.

CAN Washtenaw Profile

Our website highlights our Board of Directors at www.canwashtenaw.org/board. To help us update this page with your information, please submit the following:

One paragraph bio (please feel free to view the other board members' bios for examples):

Please upload a high quality/clear image of yourself that can be cropped into a square:

You will be asked to submit an E-Signature on the following page.

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