Please print this page, complete the application, and mail it to:              Menchville House Ministries, Inc.

                                                                                                        Attention Nominating Committee

                                                                                                        P. O. Box 22687

                                                                                                        Newport News, Virginia 23609-2687

 

Menchville House is an Equal Opportunity Employer seeking gender and ethnic/racial diversity.

 

APPLICANT INFORMATION                              Date of application:

 

Last Name:                                                            First Name:                      M.I. 

 

Street Address                                                     Apartment/Unit #

 

City                                                                           State          ZIP  

 
Home Phone (       )                                             Business Phone (       )                   

                               

E-mail Address                                                      Fax (        )    

 

Occupation:

 

RESOURCE DEVELOPMENT (Include additional pages as needed.)

Menchville House needs Board Members who are willing to work, devoting time, energy, services, contacts, material and spiritual support to the vision of moving homeless women and their children from hurt to hope. What resources/contributions/competencies/connections will you bring as a Board Member? Please be specific.

 

 

 

 

 

PREVIOUS VOLUNTEER EXPERIENCE (Include additional pages as needed.)

 

 

 

PREVIOUS BOARD EXPERIENCE  (Include additional pages as needed.)

Please list your previous board experiences (include dates):

 

 

 

REFERENCES  

1. Name                                                    Relationship 

    Address                                                 Phone (    )

    City                                                           State                 ZIP

 

2. Name                                                    Relationship 
    Address                                                 Phone (    )

    City                                                         State                 ZIP

 

3. Name                                                    Relationship 
    Address                                                Phone (    )

    City                                                        State                 ZIP

 

It is understood and agreed that the foregoing is true to the best of my knowledge.

I authorize the Menchville House to contact my references. I understand that completion of this application does not guarantee a position on the Board of Directors of Menchville House. Terms of office are for two years and must be approved by the current Board of Directors.

Signature _______________________                                     Date _________

 

The Board of Directors is grateful to you for your interest in Menchville House. Once we receive the required information from you we will do all we can to expedite the application process. Thank you.

Application for Board Member

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