Virginia Hemophilia Foundation/VHF Board of Directors Interest Form Mar 23, 2021 | Applications Please enable JavaScript in your browser to complete this form.PERSONAL INFORMATIONName *FirstMiddleLastSalutation:Mr.Ms.Mrs.Dr.OtherIf you answered other, please list here:Preferred Pronouns: He/Him/HisShe/Her/HersThey/Them/TheirsOtherIf you answered other, please list here:Home Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHome PhoneCell Phone *Personal Email *EMPLOYMENT INFORMATIONPlace of Employment *Job Title/Description *Business Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDo you prefer mail be sent to: *Home AddressBusiness AddressOtherIf you answered other, please list here:Business Phone *Business EmailEDUCATIONAL BACKGROUNDCollege/UniversityMajor/Degree and Year GraduatedCollege/University Major/Degree and Year GraduatedTrainings or CertificationsMEMBERSHIPSProfessional OrganizationsService/Social ClubsPlease list any community service or related awards you have received: REFERENCESReferences: Please list two people, not related to you who have knowledge of your qualifications *FirstLastPhone *Email *Relationship to ApplicantFirstLastPhone *Email * *Relationship to ApplicantSome positions and roles require a criminal background check. If needed, would you consent to such a check? *YesNoHave you ever been convicted of a crime, or are you currently under indictment? *YesNoIf yes, please explain:OTHER INFORMATIONPlease describe any experience you have had as a community member, donor or volunteer with VHF. How many year(s) have you been involved in some capacity? *Have you ever been involved with other non-profit organizations as a volunteer leader? If so, please list organizations and type of involvement. *What do you think are the most important duties of a Board member? *Why are you interested in serving on this Board? *Describe how your skills and values will be an asset in serving on this Board. *Our Board members are expected to attend four Board meetings each year, with several being in-person, as well as participate in regular conference calls, and attend a majority of special events. Will your schedule allow this level of participation? Are there times each month/year that you would not be available for meetings? *Board members are asked to join one or more committees. If you become a part of the VHF Board, which areas of interest do you have based on your personal and professional skills? *AdvocacyDevelopment/Event FundraisingFinancial AssistanceFinance CommitteeGovernanceProgramsScholarshipPlease explain your choices: *Any additional information you feel would be helpful to share?I confirm that all the information presented to the Foundation is accurate, true, and complete. If selected for the Board of Directors, I agree to adhere to all Foundation policies, guidelines, and values. I agree to a criminal background check if required for my position and role, and agree to report any criminal indictments or convictions which may occur during my time on the Board. *Yes, I confirm and agree.Date / Time *DateTimeNameSubmit