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Peoria Proud Board of Directors Candidate Application
Disclosure Statement: This statement is to inform any interested applicants that the answers you provide ���within this application will be utilized only for the Board of Directors’ review of all applications. Any answers can be left incomplete at the applicant’s personal discretion, and omitted information will not affect the review of the application or decision process in candidate selection.
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Name *
First Name   MI   Last Name
Pronouns *
Phone *
Email � *
Spouse’s Name (if applicable) *
Email �
Type of business or organization
Primary service(s) and area/population served
About You
Preferred Method of Contact *
Preferred Mailing Address
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Please list boards and committees that you serve on, or have served on. *
(business,civic, community, fraternal, political, professional, recreational, religious, social) Include Organization, Role/Title & Dates of Service
Education/Training/Certificates *
Have you received any awards or honors that you’d like to mention? *
How do you feel Peoria Proud would benefit from your involvement on the Board? *
Skills, experience and interests *
(Please click all that apply)
Limitations (any conflicts you have due to employment or other obligation) *
Please let us know anything else you would like to share.
Thank you for applying!
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