Board Immersion Program Application Contact Information* Mr.Ms.Mrs.Mx. Prefix First Last Email Address* Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary Phone Number*Secondary Phone NumberEmployer* Job Title* Birthdate* MM slash DD slash YYYY How did you hear about the Board Immersion Program?* Valentine Website Email Social Media Friend Referral Colleague Referral Referred by: What about the nonprofit community interests you?*What would you like to gain from participation in the Board Immersion Program at the Valentine?*More specifically, what do you hope to learn from your experience?*Have you served on a board in the past?* Yes No Please provide an overview of any volunteer experience or other programs you have participated in that make you a strong candidate for this program.*Please describe any skills, experience or specific interests you have you feel would benefit your service to the Valentine:*Please provide any additional information we should consider in reviewing your application to participate in the Board Immersion Program:*Resume/CV Upload:* Drop files here or Select files Accepted file types: pdf, Max. file size: 10 MB. ReferencesPlease list the name and contact information for one professional reference and one personal reference we may contact should you advance to the interview stage.Professional Reference* First Last Professional Reference's Preferred Email* Professional Reference's Preferred Phone*Personal Reference* First Last Personal Reference's Preferred Email* Personal Reference's Preferred Phone*Valentine Affiliations (optional)If someone affiliated with the Valentine encouraged you to apply, please list their name(s) below so that we may properly thank them for the referral.Valentine Connection(s):CAPTCHA
