Board of Directors Application

Date*

Name*

First Last

Address*

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

Phone*

Email*

Employer Name*

Type of Business/Organization

Your Title/Position

Employer Phone

Preferred Method of Contact*

Please select all that apply.

Personal Email
Personal Phone
Work Email
Work Phone

Please list any boards/committees that you serve on or have previously served on.*

Please include business, civic, community, fraternal, political, professional, recreational, religious or social)

How would CASA of Missoula benefit from your service and involvement on the Board of Directors?*

Highest Education Completed*

Additional Training/Education/Certificates you'd like to mention:

Skills, experience, interests

Please select all that apply.

Please list any groups or businesses that you could serve as a liaison to on behalf of CASA of Missoula:

Please tell us anything else you'd like to share that may be relevant to your interest in joining CASA of Missoula's Board of Directors:

Background Check Disclosure

CASA of Missoula advocates on behalf of abused and neglected childrein in the judicial system. CASA of Missoula holds high standards for confidentiality and safety regarding the children and cases referred to the program. While board members don't often deal with casework and information pertaining to individual cases, CASA of Missoula requires that its CASA volunteers, staff and board members successfully pass applicable local, state and federal background checks as necessary for their position at CASA of Missoula.

Yes, I would consent to necessary background check(s) as requested by CASA of Missoula.
No, I would not consent to necessary background check(s) as requested by CASA of Missoula.

Electronic Submission Agreement*

By checking the box below, I agree that I am the individual mentioned above and submitting this document on my own behalf. I also agree that the information listed above is true and correct to the best of my knowledge. I also understand that CASA of Missoula's Board of Directors reviews all applications and makes decisions to offer board membership based on the best interests of the CASA of Missoula program.

I agree and acknowledge the above information.

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