New Board Member Name ___________________________________________

Phone     _______________    FAX_______________    E-Mail ______________

Mentor's Name ______________________________________________________

Phone    _______________    FAX _______________    E-Mail _______________
(Mentor and candidate should read the questions, define the expectations and should discuss implementation strategies.)

_____ Mission – I understand and can promote the organization's mission.

_____ Orientation and On-Going Training – I am willing to participate in at least one activity annually affording me the opportunity to observe and better understand the organization's activities/services and people it works with.

_____ Name of Activity

_____ Date /Location of Activity

_____ Contact Person

_____ Phone                    E-Mail ____________________

_____ Additional training – I may need additional training in:


_____Mentoring – I will receive the support to build my confidence and capabilities (i.e. mentoring or buddy board member)
 
______Describe


_____Time – Knowing that good board participation requires ___ hours a month, I am prepared to dedicate the time.


_____Meetings – I will be prepared for the meetings by doing the following:


_____Assignment – I am prepared to accept a committee assignment:

_____Schedule – I have a schedule as to when the board/committee meets.

_____Outreach – I am willing to make one call per month on behalf of the organization and host one outreach (breakfast) meeting annually.


Schedule first three contacts and identify mentor/partner
Contact _______________ Mentor _______________ When _______________

Contact _______________ Mentor _______________When _______________

Contact _______________ Mentor _______________When _______________

_____Money - I am willing to make a contribution of $__________
_____Ending - I know my assignment dates: __________________

Assess your other commitments at work, school, home and other activities. Give careful consideration, ask additional questions and make your decision. I understand the requirements I can be held responsible to meet the expectations.

Any Other Special Conditions:

Signed ______________________________
New Board Member

Signed ______________________________
Board Chair