Board of Directors Candidate Application
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Full Name
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Phone Number
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Residence Address
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Employer
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Your Title at your Employer
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Employer Address
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Type of Business or Organization
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Preferred Method of Contact
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Please list boards or committees you serve on or have served on
(business, civic, community, fraternal, political, professional, recreational, religious or social organization)
Organization, Role, Dates of Service
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Organization, Role, Dates of Service
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Organization, Role, Dates of Service
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Education/Training/Certificates
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Optional: Have you received any awards or honors you would like to mention?
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How do you feel Oregon Black Pioneers would benefit from your involvement on the board
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Skills, Experience & Interests (please check ALL that apply
Please list any groups, organizations or businesses that you could serve as a liaison to on behalf of Oregon Black Pioneers
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Background Information: Please tell us a little about your talents.
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Are you available to attend mandatory monthly board meetings (in person or by phone)?
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Please tell us anything else you would like to share
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Oregon Black Pioneers
Pioneer Trust Building, Suite 210, 117 Commercial Street NE, Salem, OR 97301

info@oregonblackpioneers.org 503-540-4063 (Willie Richardson, President)

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