SRC Prospective Board Member Application

Please complete the following online application. If you have any question and concerns, please call 785-842-0543 or contact us via email.

Full Name

Email Address

Phone Number

Mailing Address

Mailing Address 2

City/Town

State/Province

ZIP/Postal Code

Yes

No

Is your home address different from your mailing address?

Home Address

Home Address 2

City/Town

State/Province

ZIP/Postal Code

How do you currently spend your time? Examples are employment, volunteer activities, etc.

If you are retired, what did you do before retirement?

Yes

No

Have you served on other nonprofit boards of directors?

Please share the organizations' name(s), the dates of your board service, and any offices or special tasks you volunteered for.

Yes

No

Are you currently a member of any organizations, such as social or civic?

Please share the organization name(s)

Yes

No

Do you have a relationship (family, friend, colleague, neighbor, etc.) to any current board members or SRC staff?

Please share the name(s) and nature of your relationship(s)

Please answer the following:

How did you become aware of the SRC?

Yes

No

Have you participated in SRC activities or events?

What skills, talents, or experiences do you bring to the Friends of the SRC Board of Directors?

Why do you want to become a Friends of the SRC Board Member?

Key Questions