Board Member Application Page

Personal Information

Name

First

Last

Date of Birth

Home Address

City

State/Province

Zip/Postal

Telephone Work *

Telephone Home

Mobile Phone *

Employer Name

Title *

Work Email *

Address *

Address Line 2

Please tell us how you would like to be contacted:

Phone

Home

Work

Cell

Mail

Home

Work

PART II -Expertise (Knowledge, skills, experience) Please check all that you are proficient in

Board Experience: Please Indicate any boards on which you currently serve or have previously served as well as any Officer positions you held:

Other Organizational Experience: Please indicate any other chartiable or community activities in which you have been/or are presently involved.

Membership and Associations (professional, social, religious, etc.): Please indicate whether they are current affiliations or past.

PART III – Pattern for Progress Board Information

What is it about Pattern for Progress that interests you in becoming a board member?

How do you envision contributing to Pattern for Progress to help achieve its mission?

Please share a Pattern report/event that was significant to you and why?

COMMITTEES and WORKING GROUPS: Each board member participates on at least one Committee. Please rate your preferences from 1 to 10 (1 being least interest)

Audit and Finance

Responsible for review of audits and financial policies.

Nominating and Governance

Responsible for board development, training, and recruiting and vetting board candidates.

Fundraising and Development

Helps Pattern to identify new membership candidates, sponsors for events and other fundraising opportunities.

Diversity, Equity and Inclusion

Helps Pattern to ensure its research and planning accounts for the needs of the full spectrum of people and places in the Hudson Valley. Also helps Pattern deliver its work to diverse audiences.

Research

Helps Pattern staff choose topics that are timely, relevant and actionable for our independent research projects.

Education and Outreach

Helps to deliver Pattern’s work to lawmakers, civic leaders, and other people who have the passion and authority to act on it.

Board Meeting Schedule-The Board of Directors meets 4 times per year in the months of March, June, September and December. Meetings are the third Monday’s of the month from 8:30-10:30 am. They are in person at the SUNY Orange Campus in Newburgh in the Great Room.

Can you regularly attend these meetings?

Yes

No

If no, how often do you believe you will be able to participate in board meetings?If no, how often do you believe you will be able to participate in board meetings?

Comments

Signature

Date

PART IV- Submittal Information

After completing this form, please attach your resume and bio

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