CrossWinds Board Member Application - CrossWinds

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800.279.3645
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CrossWinds Board Member Application

Accepting application to join the board of CrossWinds Counseling & Wellness

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone Number*
Email*
Current Position*
Current/ most recent employer*
Relevant Experience and/ or Employment:*
Please check all areas of expertise/ contribution you feel you can make to further our mission:*
- Fundraiser
- Special Events
- Legislative Contracts
- Public Policy Advocacy
- Strategic Planning
- Evaluation
- Policy Development
- Capital Campaign
- Financial/ Accounting
- Technology
- Public Relations/ Marketing
Please list prior experience serving as a Board member for other non-profit organizations.
What other volunteer commitments do you currently have?
Why are you interested in serving as a Board member?*
Please share any other information you feel important for consideration for your application as a Board candidate.
Reference 1
Name
First Last
Company
Phone
Relationship
Title
Email
Reference 2
Name
First Last
Company
Phone
Relationship
Title
Email

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Please indicate which service you’re interested in:
- Preschool
- Child/ Adolescent
- Adult
- Family & Marriage
- Adult 65+
- Medication Services
Parent Name*
Parent First Parent Last
Child Name
Child First Child Last
Email
Phone