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Board Application
Board Application
tbrill
2020-11-06T00:44:14-05:00
Board Member Application
Would you like to be a member of the NAMI Wilmington Board?
Name
*
First
Last
Address
*
Street Address
Address Line 2
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State
ZIP Code
County
*
Phone
*
Email:
*
What role do you play in the mental health community?
Peer
Caretaker
Professional
Family Member
Friend
Please indicate your current familiarity with NAMI
*
High
Moderate
Low
Which NAMI-Wilmington activity would you be interested in participating in:
*
Fund Raising
CIT Coordinator
Speaker Series Coordinator
Education or Training
Walk for Awareness
Treasurer
Other (specify)
Briefly describe/provide examples of your general background experiences and indicate how these could benefit the organization.
*
Briefly describe/provide examples of your experineces related to mental health issues and how these can benefit NAMI Wilmington:
*
Prior experience with non profit organizations and/or boards?
*
Experience in non-profit support business?
*
Specialized knowledge of one or more NAMI or other recovery program areas?
*
Other specialized training or expertise?
*
Signature
*
Date of Birth: (a DOB is necessary to perform background check. Certain offenses, i.e sexual offenses, would prohibit an individual from serving on the board member).
*
Date Format: MM slash DD slash YYYY