KRCU Community Advisory Board Application
Dear prospective Advisory Board member:

The attached questionnaire is designed to obtain information about you for KRCU Advisory Board membership consideration. If you join our group, we will list your information in our directory to create a short profile suitable for inclusion in a collection of biographical sketches. The bio should be a one-to-two-paragraph summary of your background and interest in public radio.

Please provide primary highlights only of your background, including education, career and community service.

Do not leave any sections blank, but note “n/a” if sections are not applicable.

Note: Meetings are held four times per year at KRCU or other designated location.

A term on the Advisory Board last 3 years.

Name *
Your answer
Are you a member of KRCU? *
Required
Period when you would like to serve: *
BUSINESS CONTACT INFORMATION
Preferred Contact *
If you would like KRCU to contact your work email or phone, check this box.
Required
Work Phone No: *
Your answer
Email Address: *
Your answer
Employer Name: *
Your answer
Position Held: *
Your answer
Work Address: *
Your answer
City / State / Zip *
Your answer
PERSONAL CONTACT INFORMATION
Preferred Contact *
If you would like KRCU to contact your personal email or phone, check this box.
Required
Personal Phone No: *
Your answer
Email Address: *
Your answer
Home Address *
Your answer
City / State / Zip *
Your answer
Age *
(check one box only)
COMMUNITY INVOLVEMENT
KRCU Volunteer Involvement *
Please describe any volunteer work, past or present, with KRCU:
Your answer
Other Professional Involvement *
Tell us more about your current or most recent position(s) and major area(s) of responsibility.
Your answer
What were the major product(s) or service(s) offered? *
Your answer
Date Position Held *
Your answer
Other Professional Involvement - PRESENT *
If you are involved in other community organizations, please describe one or two primary boards or community organization(s) on which you now serve and in what capacity. Please include the dates you began serving.
Your answer
Other Professional Involvement - PAST *
Please describe one or two other primary boards or community organization(s) on which you have served in the past and in what capacity. Please include the dates you served.
Your answer
OTHER INFORMATION
EDUCATION / AWARDS / RECOGNITION *
Please list degrees, special awards or recognition that you have received and dates awarded.
Your answer
Your answer
Your answer
RESIDENCE *
Local community neighborhood descriptor other than street address. How long have you lived in KRCU listening area?
Your answer
In what states or countries have you lived previously? What other radio stations are your favorites? *
Your answer
OTHER
Is there any other additional information that you would like to include?
Your answer
Please enter today's date. *
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