Date:  Click here to enter text.        Full Name:  Click here to enter text.        Email:  Click here to enter text. 

Address:  Click here to enter text.     City:  Click here to enter text.     State:  Click here to enter text.           

Zip:  Click here to enter text.     Phone (H):  Click here to enter text.     Phone (C):  Click here to enter text.                             

Business Name:     Click here to enter text.

Address:     Click here to enter text.        City:  Click here to enter text.             

State:  Click here to enter text.             Zip:  Click here to enter text.

Title:  Click here to enter text.         Phone (W):  Click here to enter text.

Please indicate the area for which you are applying:

Community        

Financial        

Legal                

Technology        

Other (specify)                Click here to enter text.

Briefly describe your interest in this volunteer opportunity & how you can serve communities through our organization?

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Please outline any experience with advisory committees or non-profit organizations?

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What skills, perspectives, experiences and qualities would you bring to MnACC?

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Give the number of years you will be willing to serve on our volunteer advisory council (1 year Minimum).

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Service can be terminated prior to end of commitment term due to irreconcilable differences or can be extended where continued partnership is mutually beneficial and agreed to by both parties.

Please indicate the days & times you would be available for meetings.

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Please list 2-3 references that we may contact:

  Name:         Click here to enter text.                                 Phone or Email:  Click here to enter text.

  Name:         Click here to enter text.                                 Phone or Email:  Click here to enter text.

Name:         Click here to enter text.                                 Phone or Email:  Click here to enter text. 

Recommended by:  Click here to enter text.

                   (list the name & phone number or entities name, contact person & phone number if you are recommended)

Incomplete and/or falsified applications will automatically be disqualified from further consideration.  My signature below acknowledges that I have read and understood the above.

Signature:  Click here to enter text.     (if completing electronically, please type your full name to serve as your signature)

Upon receipt of this application and materials, you may be contacted for a follow-up interview.

1/18/2013