Board of Directors Nominee ApplicationBoard of Directors Nominee Application Upholding the Mission - Forwarding the Vision...TOGETHER! SECTION 1: CONTACT & DEMOGRAPHIC INFORMATIONFirst Name Last Name Date of Birth AddressAddress Line 1 Address Line 2 City State Zip Code Country Select CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweEmail Phone Number Ethnicity African American/Black Caucasian/White Latino/Hispanic Asian OtherGender Pronouns SECTION 2: BACKGROUND INFORMATIONThis information is vital in determining how best to make this a mutually beneficial partnership. Please, be transparent and thorough.Current Employment Status Full Time Part Time Retired Seeking Employment OtherEmployer/Company Name Years with Current Employer Years in Current Field Current Occupation What is Your Professional Background? What Other Volunteer Positions Have You Held or Currently Hold? Please List Your Collegiate Experience & Degrees, if Applicable SECTION 3: MISSION ALIGNMENTIt is of utmost importance that each member of our team - from Program Facilitators to Child Care Volunteers - understand and align with the mission, vision, and cultural creed of this organization. GBTM MISSION - Promoting healing, wholeness, and freedom through our artistic approach to holistic health & well-being. GBTM VISION - God's Butterfly THE MOVEMENT exists to provide a safe space for Creatives to express artistically, cultivate their artistry, and find healing through the arts. The change effected by our organization will be recognized as a much needed resource in every community we enter, as we become accountability partners to those we serve. In What Ways Have You Interacted With Our Organization In the Past? (Committee member, Client, Donor, Event Attendee, etc.) How Does Our Mission Resonate With You? Why Is it Important To You? Why Do You Want to Be On Our Board? SECTION 4: GOVERNANCEIf You Have Served or are Currently Serving On a Board, Please List the Last Three, Dates of Service, and Reason For Leaving (if applicable). Do We Have Your Permission to Contact The Organizations Above, To Inquire of Your Board Service With Them? Yes No Not ApplicableEach year, every board member is required to disclose any potential conflicts of interest as a board member. Please describe any conflicts of interest you would need to disclose if you joined the board: Board meetings are scheduled for the last Thursday of each month from Noon to 2PM. Are you available at this time? Yes NoThe minimum expectations for board members are listed below. Please confirm your ability and willingness to meet each. If selected for the board: I will attend and actively participate in at least 8 of the 10 monthly Board Meetings. I will make a personal annual financial gift at a level that is personally significant to me. I will raise at least $500 annually for the organization, by direct solicitations, selling event tickets, or other fundraising activities. I will serve on at least one committee and attend at least 85% of the committee meetings. I will establish at least 1 (one) relationship on behalf of the organization.Please select the best dates and times for your board nominee interview. Make as many selections as possible, to making synchronizing schedules more likely. December 4th @10am December 4th @11am December 4th @1pm December 4th @2pm December 4th @5pm December 4th @6pm December 4th @7pm December 5th @10am December 5th @11am December 5th @1pm December 5th @2pm December 5th @5pm December 5th @6pm December 5th @7pm December 7th @10am December 7th @11am December 7th @1pm December 7th @2pm December 7th @5pm December 7th @6pm December 7th @7pm December 8th @10am December 8th @11am December 8th @1pm December 8th @2pm December 8th @5pm December 8th@6pm December 8th @7pmSubmit Form