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Board Nomination Form

Submit a nomination for a colleague or peer to join the company's board of directors, including their experience and your reasons for recommending them.

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Board Position Title

Nominee Name

Nombre

Apellido

Nominee Phone Number

Nominee Email

Nominee Address

Dirección

Ciudad

Estado / Provincia

Código postal

Current Work

Position/Title

Employer Name

Nombre

Apellido

Employer Phone

Employer Email

Employer Address

Dirección

Ciudad

Estado / Provincia

Código postal

Does the nominee have any board member experience?

Yes No

If Yes, Please Provide Details Below

Company Name

Position/Title

Duration

Why do you think this Nominee should win the position?

What are the strengths of the Nominee?

What are the related skills of the Nominee?

Does the nominee/candidate have the following experience? Please select all that apply:

Leadership experience Fundraising experience Financial management Strategic planning Public speaking

What can the Nominee add to the company by being member of the board?

Are you nominating for yourself?

Yes No

If No, What Is Your Relationship to the Nominee?

Signature

Sign here

Date Signed

Nominator Information

Your Name

Nombre

Apellido

Your Phone

Your Email

Does the candidate know what you are nominating him/her?

Yes No

Signature

Sign here

Date Signed

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