Proteus Board Nomination Questionnaire

The Nominations Committee of the Board of Directors is responsible for recruitment of people to fill vacancies on the Board. The Committee is charged with finding willing volunteers from various backgrounds, with different areas of expertise who can offer unique perspectives on issues and, when combined with the other members of the Board, will strengthen the ability of the Corporation to establish effective policies, procedures and directions. You are invited to complete this form, supplemented with additional information if you like, so that the Committee will be able to include you among its future candidates for appointment to the Board. Thank you for taking the time to do this and for your interest in Proteus, Inc. and the people which it serves.

I. SPECIFIC INFORMATION

Full Name: (First, Last)

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Address (Street, City, State, Zip)

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Telephone

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I. SPECIFIC INFORMATION

Business Name

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Business Address (Street, City, State, Zip)

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Business Telephone

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II. BUSINESS, PROFESSION OR EMPLOYMENT Briefly describe your place of business or place of employment. Tell what, if any, the relationship of your business or professional involvement is with regard to low-income people.

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III. PERSONAL INFORMATION Please provide a brief synopsis about yourself, your background, etc., so that the Committee can gain a feeling of who you are – what your experiences have been. You might include such details as your family background, your educational experiences, any previous experience with Proteus, Inc. or other programs for low-income people, or anything else that will give the Committee a feel for you as a person and a prospective Board Member.

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IV. OTHER ORGANIZATION(S) WITH WHICH YOU ARE ACTIVELY ASSOCIATED

Name of Organization

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Address (Street, City, State, Zip)

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Which cities and counties does this organization serve?

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Types of services provided

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Name of Organization

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Address (Street, City, State, Zip)

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Which cities and counties does this organization serve?

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Types of services provided

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Name of Organization

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Address (Street, City, State, Zip)

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Which cities and counties does this organization serve?

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Types of services provided

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IV. OTHER ORGANIZATION(S) WITH WHICH YOU ARE ACTIVELY ASSOCIATED

Briefly describe the type of activities conducted locally and the impact that those activities have on the low income people of Tulare, Kings, Fresno and Kern Counties

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Describe your association (eg., member, staff, officer, volunteer, etc.) and the nature of your involvement:

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V. PERSONAL INTEREST IN FARMWORKERS OR OTHER LOW INCOME PEOPLE OF THIS AREA:

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I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may render for refusal of this application Invalid Input

Today's Date

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Please feel free to supplement this Nomination Questionnaire with additional data for discussion which you believe would be helpful to the Committee in its deliberations.

File Upload

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Contact Info

CALL: Toll Free: (888) 776-9998
VISIT: 1830 N. Dinuba Blvd. Visalia, CA 93291
HOURS: Monday - Friday: 8:30 AM - 5:00 PM Saturday - Sunday: CLOSED
EMAIL: info@proteusinc.org

Proteus Board Nomination Questionnaire

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