Referral Form for Board of Directors or Board Development Committee

This form is designed for the purpose of submitting names of individuals to the Board Development Committee for possible consideration for Board of Directors or Board Development Committee positions.  It does not indicate this person will be nominated to the Board of Directors or Board Development Committee.  The process includes:

  1. Submitting this referral form.

  2. Being selected for consideration.

  3. Interviewing with the Board Development Committee

  4. Being placed on the single slate ballot.

  5. Being elected at the annual council meeting.

Requirements for Board Members:

  1. Commitment to the Girl Scout mission.

  2. Relinquishing of Girl Scout operational management functions (i.e. Girl Scout troop leader, service unit team member, etc.)

  3. Willingness to join Girl Scouts of the USA.

  4. Willingness to sign a Conflict of Interest statement.

  5. Willingness to make a financial commitment to Girl Scouts of Western Ohio.

 

 

 

 

 

 

 

This referral is being submitted by:

Prospect is being submitted for the suggested position of:   Board of Directors     Board Development Committee

Is the prospect aware their name has been submitted for consideration?  Yes    No

Prospect's Name:

Home Address:

City:    State:     Zip:

Day Time Phone:     Evening Phone:    Mobile Phone:     Fax Number:

Place of Employment:

Position:

Email Address:

What is their geographic location:  Appleseed Ridge    Buckeye Trails    Great Rivers    Maumee Valley

Is the prospect currently involved in Girl Scouting?  Yes    No

If yes, in what capacity?

 

What is prospect's history in Girl Scouting -- a girl member, an adult member? 

 

What is prospect's experience in community involvement other than Girl Scouting?

 

Prospect's education (please list colleges attended and degrees earned:

 

What is prospect's volunteer/professional experience?

 

What strengths would this prospect bring to Girl Scouts of Western Ohio?

 

The council covers the western portion of Ohio.  Does the prospect have any concerns with traveling about four times a year to meetings?  Yes  No

State briefly why you think the prospect should be a member of Girl Scouts of Western Ohio's Board of Directors or Board Development Committee:

 

Additional Comments:

 

OPTIONAL DATA -- Girl Scouts of Western Ohio is committed to representing a diverse population.  The following information will be used in considering this prospect to ensure that we remain an inclusive organization.  This information will not eliminate any prospects.  Please feel free to answer by checking all that apply.

Race:  White    Black    Asian    Native American    Hispanic    Other

Age Group:  14-18     19-30     31-45     46-60     Over 60

Religion:  Catholic     Protestant     Jewish     Other

Disability:  Mentally Challenged     Hearing     Learning     Visual     Physical     Other