Become A Board Member

Would you like to become a Board Member?

ERC was formed with the goal of establishing comprehensive programs and services that allow individuals to make healthier choices. We do this by translating service gaps and community needs into a wealth of viable health-related alternatives. No one individual has the required expertise or time to “do it all”. This effort requires the cooperation of a team with varied talents, ranging from the social sciences, through business community contacts, to local support systems, and volunteers. For this reason, ERC seeks a broad-based Board of Directors, comprised of individuals with exceptional qualities and direct ties to the community.

If you are interested in becoming a Board Member, fill out our Board Member Application below:

Board of Directors Application Date

Name (required)

Home Address (required)

City (required)

State (required)

Zip Code (required)

Home Phone (required)

Home Fax

Personal Email (required)

Gender (required)

Birth Date

Business/Organization:

Business Address:

City

State

Zip Code

Business Phone

Business Fax

Business Email

Please contact me at Home

Please contact me at Business

Emergency Contact

Relation

Phone 1

Phone 2

EDUCATION

Undergraduate Institution

Degree & Major

Graduate Institution

Degree & Program

Activities

Honors/Awards

Why are you interested in serving on the Board of Empowerment Resource Center?

What skills/experience can you contribute to Empowerment Resource Center?

What are your particular interest areas in regards to serving on the Board of Directors for a community-based, non-profit organization?

What other professional or social organization(s) are you a director/member of?

I certify that the information I have provided is true and accurate to the best of my knowledge.

Print Name (required)

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