Yes, I would like to enroll in the Community Leadership Board Bank.

I am interested in being considered for a board position with an area nonprofit agency. (You may be listed as available for board placement only if you have experience on a board and/or have had boardmanship training.)

I am interested in serving on a board but do not have the requisite experience or training. Please send me information on the Hartford Courant/United Way Board Training Institute.

Please update my registration information.

Volunteer Information
All individuals in the Community Leadership Board Bank must be willing to have their name and phone number distributed to agency staff or volunteers to contact them directly.

First name                           Initial  Last name


Street Address

(Address continued)


City/State/Zip

Work Phone                    Home Phone                Fax
()    ()    ()  

Email

By providing my email address, I would like to receive periodic email updates from
United Way of the Capital Area.

Employer

Title/Occupation

Do you have current or previous experience on a board of directors?
Yes    No

If yes, please fill in the table below.

              Agency Name                              Position Held       
  
  

Areas of Care
Please select one or more of the following program service area(s) that describes your preference.

basic human needs                                  
children and youth services                    
community organizing/planning               
cultural heritage/museums and history     
diversity/empowerment                          
education/literacy                                       
family life education                                    
healthcare
home care
housing
information and referral hotlines
legal services
mental health/counseling
nature/environment
people with disabilities
protective service/abuse
recreation/enrichment
services for the elderly
workforce development
visual and performing arts
other (please type below):

Area(s) of Expertise
Please select up to three of the following areas in which you have experience.
accounting
capital campaign
community organizing
communications/marketing
counseling
events planning/management
finance/budgeting
long-range and strategic planning
medical professional
personnel/human resources
program development
public speaking
research/data collection
training/educating
writing/editing
volunteer management/recruitment
other (please type below):

How did you find out about the Community Leadership Board Bank?
United Way of the Capital Area
Leadership Greater Hartford
Community Conversations on Race
DemocracyWorks
National Conference for Community Justice
The Hartford Courant/United Way Board Training Institute
other (please type below):

Signature

Typing your name will serve as your signature, or you may print this form out and mail or fax it to: United Way of the Capital Area, 30 Laurel Street, Hartford, CT 06106-1374, ATTN: Marsha Mason, Fax: (860) 493-1199.

If you have any further questions regarding the Community Leadership Board Bank please use the space below.