Board Application

Your Information

Thank you for your interest in becoming a Board member at the Boys & Girls Club of Janesville. The following questions will help us learn a little more about you, and your fit with our team. The Boys & Girls Club of Janesville exists to inspire and enable all youth, especially those who need us most, to realize their full potential as productive, caring, and responsible citizens.

Please know your comments will be kept confidential but will be used by our Board Development committee.

If you are uncomfortable submitting any of your answers electronically or have any questions at all, please feel free to personally reach out to one of our committee members.

Thanks for taking the time to answer these questions and helping us to ensure that Great Futures Start Here.

Name:

Street Address:

State:

City:

Zip:

Employer:

Employer Street Address:

Employer State:

Employer City:

Employer Zip:

Title / Position:

Work Phone:

Cell Phone:

Preferred Contact:

Home

Business

Preferred Email Address:

Source of Referral / Information:

What do you know about the Boys & Girls Club?

Please give a description of your past work experience:

What's your current community involvement (Boards, volunteer work, community groups, etc.)?

What other affiliations, club memberships, etc. might you have (past or present)?

Do you have any past experience with the Boys & Girls Clubs? If so, please explain:

What education, field of study, or military experience might you have?

What committees are you interested in serving on? Please indicate a first, second, and third choice below.

Resource Development / Marketing and Communications Committee assists with fund development, donor stewardship, annual campaigns and larger resource development efforts, donor recognition projects, and recommendations regarding communications and public relations.

Diversity, Equity & Inclusion Committee provides guidance and consultation for establishing growth in the Corporation’s commitment to diversity, equity and inclusion efforts as an employer, service provider, and community member.

Board Development Committee supports and ensures the recruitment, selection, orientation, accountability, on-going education of the Board, and Board member recognition.

Finance/Legal and Insurance Committee reviews all financial affairs, legal matters, regulatory compliance, and insurance.

Safety Committee reviews the Safety and Crisis Management Manual and ensures adherence to all safety measures required by the Corporation and BGCA.

First Choice:

Second Choice:

Third Choice:

What events might you be interested in working on?

Golf Outing

Fall Event (theme varies)

Turkey Trot

Pheasant Hunt

Shamrock Run

Are you able to attend meetings and donate time and resources to the Club?

Yes

No

Why are you interested in becoming a Board member of the Boys & Girls Club?

Any other information you would like to share?

Finally, please provide the names and contact information for three references. At least one reference should be a professional contact.

Reference Name:

Reference Phone Number:

Reference Email Address:

Reference Name:

Reference Phone Number:

Reference Email Address:

Reference Name:

Reference Phone Number:

Reference Email Address:

Your Information

200 W Court Street | Janesville, WI 53548 | 608-755-0575