Nomination Form for Election to the Board of Directors January 1, 2018 Nominee: Name Nominator: Name Occupation: Occupation Title: Title Employer: Business Name Address: Street Address City, State Zip Phone: (555) 555-5555 Email: Email Do you support Friendly House’s mission? ☐ Yes ☐ No Why do you feel passionately about Friendly House’s mission? Click here to enter text. What will you bring to the board? i.e.: skills, expertise, contacts, and resources Click here to enter text. Committee interests: Please indicate your top two committee choices ☐ Finance ☐ Program & Planning ☐ Facilities ☐ Fund Development ☐ Auction ☐ Board Resource ☐ Equity & Diversity ☐ IT Would you be willing to serve on the Executive Committee during one or more years of your term by chairing a committee or being an officer? ☐ Yes ☐ No Which role? Click here to enter text. Are you able to attend board orientation during the 3 rd week of September? ☐ Yes ☐ No Are you able to attend the board retreat on a full Saturday in April? ☐ Yes ☐ No Are you willing to consider Friendly House number one or two among the nonprofits you support, in terms of your time and donations? ☐ Yes ☐ No Will you attend Friendly House’s annual auction and invite at least 9 individuals to attend with you? ☐ Yes ☐ No Are you willing to attend board meetings (Usually 9 per year, for approximately 2 hours)? ☐ Yes ☐ No