Trustee Info Form Trustee Profile Form Used to obtain contact information and other helpful data. Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Contact InformationPreferred Email* Mobile PhoneHome Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone (if applicable)Employer (if applicable) Job Title (if applicable) Business Address (if applicable) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone (if applicable)Name of Administrative Assistant (if applicable) Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Email for Administrative Assistant (if applicable) Please send all mailed correspondence to* Home Address Business Address Other InfoBirthday MM slash DD slash YYYY Self-Identified Race & EthnicityNote: Categories are listed as requested by GuideStar. This information is used for the tallies and percentages we are required to submit to report on our board demographic makeup for the Valentine's GuideStar profile and additional grant applications. Asian American/Pacific Islanders/Asian Black/African American/African Hispanic/Latino/Latina/Latinx Native American/American Indian/Indigenous White/Caucasian/European Multi-Racial/Multi-Ethnic (2+ races/ethnicities) Decline to state FamilySpouse's Name (if applicable) Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Spouse's Birthday (optional) MM slash DD slash YYYY Names and ages of children (if applicable)Occupational History, Community Engagement and Other Interests**In lieu of completing this portion of the form, you may upload a recent resume or CV below or email to hmclaren@thevalentine.orgCV UploadMax. file size: 50 MB.Previous OccupationsEducationAdditional Board ServiceProfessional/Civic AssociationsSocial Club MembershipsCommunity ActivitiesReligious AffiliationOther Interests
