Board of Director’s Application
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Personal Information
Please fill out each field completely.
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| Name |
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| Address |
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| Phone Number |
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| Email |
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Board Applicant Information
Please fill out each field completely
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| I am from Region |
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Have you ever been a representative/alternate on
the Board of Directors for People First of
Louisiana |
YES
NO
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| Are you a graduate of Partners in Policy Making? |
Yes
No
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Will you have support to attend and participate in
the People First of Louisiana Board
meetings/trainings? |
Yes
No
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If you answered NO to the previous question please
explain what assistance you will need. (example:
Travel to and from meetings, support during the
meetings, etc) |
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Have you read the People First of Louisiana
Mission Statement? |
Yes
No
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Do you agree with the Poeple First of Louisiana
Mission State |
Yes
No
I haven’t read it
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| Explain your answer above |
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Have you read the People First of Louisiana Vision
Statement |
Yes
No
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Do you agree with the People First of Louisiana
Vision Statement? |
Yes
No
I haven’t read it
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| Explain your answer above |
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Advocacy Experience
Advocacy mean to actively support an idea or cause
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Please list any past and current advocacy
experience |
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| Are you a member of People First of Louisiana? |
yes
no
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| Please list any other advocacy organizations here: |
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References
Please list name and contact information of 2 people that know of your advocacy activities. Also, list the name and contact information of a friend or family member.
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| Reference 1 |
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| Home Phone |
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| Cell Phone |
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| Email |
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| When is the best time to contact this person |
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| Reference 2 |
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| Home Phone |
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| Cell Phone |
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| Email |
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| When is the best time to contact this person |
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| Friend/Family Member |
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| Home Phone |
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| Cell Phone |
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| Email |
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| When is the best time to contact this person |
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Acknowledgement Form
I have read People First of Louisiana Board of Directors “Position and Responsibilities”. I agree to fulfill the reposnsibilitiesto the best of my ability and represent People First of Louisiana as a leader in building self-advocacy in Louisiana.
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| Electronic Signature |
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| Date |
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