First and Last Name *

Pronouns

We strive for an inclusive community in our overall membership, as well as on our board and committees. If you hold any specific identities you would like to share with the current Board Members, please elaborate below (i.e., gender identity, sexual orientation, race, ethnicity, socio-economic status, abilities, religion, family structure, national origin, etc.).

Phone Number *

Address

Email *

What are you applying for? Select all that apply. Learn more about our board and committees here: https://www.openmadison.org/Committees and https://www.openmadison.org/page-733407 *

What do you find meaningful about OPEN's mission and vision? You can read them here: https://www.openmadison.org/page-572429 *

What are some of your prior board, committee, community, etc. leadership experiences? Please include the name(s) of the organization and your role(s). NOTE: no prior experience is necessary! *

What skills, connections, resources and expertise do you have to offer on behalf of OPEN? *

How much time a month can you commit to meetings and events? Board membership typically requires 2-4 hours a month in attendance to Board and Committee meetings. *

Do you have any conflicts of interest? *

Which of your skills would you like to utilize on the Board and/or Committee? Check those that apply: *

Signed Name *

Date *