2020 107IST Board Nominee Application

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This form must be fully completed and submitted by noon December 12, 2020. You must be an active 107IST member as of October 31st, 2020, to be nominated to the board of directors for the 2021 term.

As a nominated board member, this Statement of Understanding will be the basis for your board responsibilities. (https://drive.google.com/file/d/1Aj2Hd6MV4RSHaWWWqnMMHIQg20WHu2tp/view?usp=sharing)

Name *

Email address *

Please list the boards and committees that you serve on or have served on (business, civic, community, fraternal, political, professional, recreational, religious, social):

Biographical information, both 107IST-related and professional (250 words or less):

State your objectives as a 107IST board member (150 words or less):

How do you feel 107IST members would benefit from your involvement with the board? (150 words or less)

Profile picture *

Please provide a photo to be posted with your biographical information on the 107ist Board of Directors page at 107ist.org.

I will email a photo of myself to elections@107ist.org by the submission deadline.

107IST Conflict of Interest Disclosure *

Board members are likely to be affiliated with many organizations in their communities, both on a professional and a personal basis, so it is not unusual for actual or potential conflicts of interest to arise. Board service carries with it important ethical obligations. Board members have a legal responsibility to assure the prudent management of an organization's resources. Board members can be held legally liable for conflict of interest because it constitutes a breach of fiduciary responsibility. All conflicts must be disclosed when candidacy is filed. Conflicts of interest are defined in Article X of the 107IST bylaws at https://timbersarmy.org/resources/Documents/107ist%20Bylaws_2020.pdf. List all possible conflicts of interest. (Required. Enter 'None' if you do not have any.)

In addition to listing all conflicts of interest and disclosures, all candidates applying to become a 107IST board member must read and understand the following statement: *

107 Independent Supporters Trust board members must scrupulously avoid any conflict of interest between the interests of 107IST and its members on one hand, and personal, professional, and business interests on the other. This includes avoiding actual conflicts of interest as well as perceptions of conflicts of interest. I understand that the purposes of this policy are: to protect the integrity of the 107IST decision-making process, to enable our members to have confidence in our integrity, and to protect the integrity and reputation of members and board members. If elected to office, in the course of meetings or activities, I will disclose any interests in a transaction or decision where I (including my business or other nonprofit affiliation), my family and/or my significant other, employer, or close associates will receive a benefit or gain. After disclosure, I understand that I may be asked to leave the room for the discussion and may not be permitted to vote on the question.

CERTIFICATION: By checking this box I confirm that the above statements are true, that I agree to have the information published as-is on the 107IST election ballot along with any conflict of interest disclosures, and I have read and understood the above conflict of interest statement.

Required

Date submitted: *

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