Committee/Board Application Form
Essence Of Mind
Name *
Address (with zip code) *
Email *
Phone number *
Current or most recent job title (with employer name) *
Educational Background (degrees and dates) *
Are you passionate about Advocacy work? If so, please give examples:
Are you available for meetings twice a month 7 pm? Days may vary as well location.
Clear selection
Professional accomplishments and published works: *
Service on committees or other organizations: *
Statement of your job responsibilities relating to our committee: *
Are there any special contributions you can make to the work of Essence Of Mind? *
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