Board of Directors Application "*" indicates required fields Name* Rev.Mr.Mrs.MissMs.Dr.Prof. Prefix First Last Employer*Office Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Personal Email Address* Work Email Address* Office or Home Phone*Cell Phone*Employment history and relevant volunteer experience*Why are you interested in serving on the Board of our organization?*Other volunteer commitments*Other information you would like to shareArea(s) of experience/expertiseCheck all that apply. Finance/Accounting Governance HR Legal Programming Spiritual Care Fundraising/Grant Writing Demographic InformationThe information you provide is used only by the Board’s nominating committee for diversity, equity and inclusion purposes. Collectively the aggregated information will be shared with the board in order to fulfill our DEI strategy. This section is optional.Are you an ordained minister?NoYesIf yes, what denomination?Are you a UCC member?NoYesIf yes, church name and city?What is your DOB? MM slash DD slash YYYY Sexual Identity – Who You LoveWhich of the following best describes you personally? Asexual Bisexual or pansexual Lesbian or gay Straight or heterosexual Queer Prefer not to answer Prefer to self-describe Sexual Identity - Please Self-DescribeGender – Who You Say You AreWhich of the following best describes you personally? Man Non-binary Woman Prefer not to answer Prefer to self-describe Gender - Please Self-DescribeGender Identity – How You FeelDo you personally identify as transgender? Yes No, I am cisgender No, but I do not identify as cisgender Prefer not to answer Prefer to self-describe Gender Identity - Please Self-DescribePronouns – What You Want to Be CalledWhat are your pronouns? She/Her He/Him They/Them Prefer not to answer Prefer to self-describe Pronouns - Please Self-DescribeRace American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Prefer not to answer Prefer to self-describe Race - Please Self-DescribeEthnicityAre you of Hispanic, Latino/a/x, or of Spanish origin? (one or more categories may be selected) No, not of Hispanic, Latino/a/x, or Spanish origin Yes, Mexican, Mexican American, Chicano/a/x Yes, Puerto Rican Yes, Cuban Yes, Another Hispanic, Latino/a/x or Spanish origin Some other race, ethnicity, or origin Prefer not to answer Prefer to self-describe Ethnicity - Please Self-DescribeAre you a person with a disability?*NoYesWhat accommodations can we provide for your participation and belonging?CAPTCHA Δ The demographic questions and categories were derived from the HRC and Harvard.
