Kids Moving & Thriving Board of Directors Candidate Application
Email address *
Name (First, MI, Last)
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Address (Street, City, State, Zip)
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Phone Number (area code first)
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Employer/School Information
Employer name (May put institution of higher education if you are a full time student)
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Job Title (Please indicate major course of study if you are a full time student)
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Address (of employer or school if you are a full time student)
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Please give a brief description of your employer and the nature of the business (primary services, populations served, etc.). If you are a full time student, briefly describe your career aspirations.
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Skills, experience and interests (please check all that apply)
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 and dates of service.
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Education/Training/Certificates
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How do you feel Kids Moving & Thriving would benefit from your involvement on the Board?
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Please list any groups, organizations or businesses that you could serve as a liaison to on behalf of Kids Moving & Thriving.
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What area of expertise/contributions do you feel you can make with serving as a board member for KM&T?
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The KM&T board meets at least once a month (on the first Tuesday at 6pm). Do you see any scheduling problem that might affect your attendance?
If yes or maybe please explain your conflict.
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Have you received any awards or honors that you’d like to mention?
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Please tell us anything else you’d like to share.
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A copy of your responses will be emailed to the address you provided.
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