Full Name *

Preferred Pronouns

Date

Email *

Phone *

Mailing Address

Address

Street Address

City

State

Country

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Postal Code

LinkedIn / Website

Current Employer & Title *

Years of Relevant Professional Experience

Brief Professional Summary  *

Prior Nonprofit Board or Committee Experience

Areas of Expertise

Finance/Accounting

Legal/Governance

Education Policy

Workforce/Logistics

Fundraising/Development

Communications/Marketing

Government Relations

Other

Other (if selected)

Why are you interested in serving on the KRoussaw Foundation Board? *

How do you see yourself contributing to KRF's mission and programs?

Familiarity with KRF's Mission, Vision, and Discover / Educate / Transform / Workforce Empowerment pillars

I can attend quarterly Board meetings in person at the KRF office in Washington, DC.

I can serve on at least one standing committee, per the Foundation's committee structure.

I understand and am willing to meet the annual give-or-get contribution expectation.

I have read the Board Member Job Description provided with this application.

I can commit to a Board term of one year, renewable annually for up to three additional terms (up to four years total).

Do you currently serve on any other nonprofit or for-profit board? *

Yes

No

If yes, please explain (board service)

Are you aware of any potential conflict of interest with KRF's mission or operations? *

Yes

No

If yes, please explain (mission conflict)

Do you have a personal, financial, or familial relationship with any current KRF director or staff member?  *

Yes

No

If yes, please explain (staff relationship)

Reference 1 — Name

Reference 1 — Relationship

Reference 1 — Phone

Reference 1 — Email

Reference 2 — Name

Reference 2 — Relationship

Reference 2 — Phone

Reference 2 — Email

Signature (type full name) *

Signature Date