Volunteer Application | Your Safe Haven, Inc.

Date(Required)

Thank you for your interest in serving on the Board of Directors. Board members play a vital role in providing governance, strategic direction, fiscal oversight, and community leadership to support the mission of the organization.

APPLICANT INFORMATION

Name(Required)

First Last

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Employer(Required)

Occupation/Title(Required)

Preferred method of contact(Required)

Phone

COMMUNITY INVOLVEMENT

Please list any current or previous nonprofit, civic, professional, religious, educational, or community organizations with which you have been involved.(Required)

Organization | Role/Position | Dates of Service

INTEREST IN BOARD SERVICE

1. Why are you interested in serving on the Board of Directors?(Required)

2. Are you familiar with our mission and programs?(Required)

Yes

What interests you most about our mission and services?(Required)

3. What do you hope to contribute as a board member?(Required)

BOARD EXPECTATIONS

Board members are expected to:

• Attend regular Board meetings.
• Serve on at least one committee.
• Maintain confidentiality regarding organizational matters.
• Act in the best interests of the organization.
• Assist with fundraising and community awareness efforts.
• Review materials and prepare for meetings.
• Support the mission, vision, and values of the organization.

Can you commit to fulfilling these responsibilities?(Required)

Yes

If no, please explain:

SKILLS AND EXPERIENCE

Please check all areas in which you have experience, expertise, or interest.

Other

Briefly describe any specialized skills, certifications, or experience that would benefit the organization.(Required)

IF YOU WOULD LIKE TO SERVE AS A DIRECT SERVICES OR ADMINISTRATIVE ASSISTANCE VOLUNTEER

When is the best time for you to volunteer?(Required)

Morning

Afternoon

Evenings

All Day

Limited Hours

Areas of Interest(Required)

Making/receiving calls

Outreach Events

Assist at school presentations

Event tear down and/or Set up

Paperwork Support

Advocate Assistance Responsibilities (training required)

POTENTIAL CONFLICTS OF INTEREST

Do you have any relationships, business interests, or affiliations that could create a conflict of interest with the organization?(Required)

Yes

If yes, please explain:

REFERENCES

Please provide two professional or community references.

Reference #1 Name(Required)

Reference #1 Relationship(Required)

Reference #1 Phone(Required)

Reference #1 Email(Required)

Reference #2 Name(Required)

Reference #2 Relationship(Required)

Reference #2 Phone(Required)

Reference #2 Email(Required)

ADDITIONAL INFORMATION

Please provide any additional information you would like the Board Governance Committee to consider.

CERTIFICATION

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that submission of this application does not guarantee appointment to the Board of Directors.

Signature

Date