BOD Candidate Statement of Interest Form

Please complete this form if you are interested in joining the Board of Directors for the Florida Wildlife Hospital. This is a competitive process and all forms will be reviewed for our current needs. Once you complete the form, click the Continue button at the bottom.

Name and address

First name:

Last name:

Title:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

OK to call me here

Work phone:

OK to call me here

Cell phone:

Email address:

Date of birth:

(year optional)

Ethnicity:

Current FWH Affiliation:

Employer Information

If retired/unemployed, please provide information for your most recent employer.

Your Title:

Typical Work Schedule:

Employer:

Street 1:

City:

State:

Zip:

Work phone:

Email address:

Type of business/organization and primary service(s):

Preferences

Preferred Method of Contact:

Statement of Interest

Why would you like to serve on the FWH Board of Directors?

FWH Benefit

Please describe your specific areas of interests and the skills that you believe you will bring to the FWH Board of Directors?

Community Involvement

Do you currently or have you served on any other boards and committees (business, civic, community, fraternal, political, professional, recreational, religious, social)? Please describe that experience.

Education/Training/Certificates

Please provide your University/College/School and any specialized training or certificates you have acquired.

Optional – Have you received any awards or honors that you’d like to mention?

Education:

Community Relationships

Are you associated with any local entities of which you could serve as a liaison to the FWH?

Skills, experience and interests

Please check all that apply.

Additional Information

Please tell us anything else you’d like to share.

I understand that by sumbitting this form, I am in no way guaranteed a position on the Board of Directors at the Florida Wildlife Hospital. Any vacant positions will be evaluated for the needs of the organization and only individuals meeting those needs will be chosen for the next process of becoming an FWH Board Director.

I Agree