Prospective Board Member Information Form "*" indicates required fields Name* First Last Current Organization / Company & Title*(if relevant) Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Cell Phone Number*Which best describes you?*Select all that apply Asian American Indian or Alaskan Native Black or African American White Hispanic, Latinx, or Spanish origin Middle Eastern or North African Native Hawaiian or other Pacific Islander Some other race, ethnicity, or origin Prefer not to answer Special Skills*Select all that apply Administration / Management Advocacy / Public Policy Corporate Governance Education Entrepreneurship Finance / Financial Management / Banking Fundraising Government Healthcare / Medical Hospitality Human Resources Insurance Leadership Coaching Legal Marketing / PR / Communications Nonprofit Management Operations Program Development Real Estate Digital Media Strategic Planning Technology Other Professional Background*Select all that apply For profit business Nonprofit organization Government Other If "Other" chosen above for Special Skills and/or Professional Background, please describe below: Why does the BluePath mission resonate with you?*Are you currently serving on any other Boards or have you served on Boards in the past? If so, which ones and when?*If appointed to the Board, what level of financial contribution are you prepared to annually contribute or secure for BluePath?*Anything else you’d like to share?Upload resume or bio, with at least two references.* Drop files here or Select files Max. file size: 50 MB. CAPTCHA 27835
