| Date
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First Name
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Last Name |
Personal Information |
Home Address
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City
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State
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Zip
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Home Phone
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Cell Phone
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| Email Address
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Professional Information |
| Professional Role/Position |
| Company |
| Work Address |
Work Phone
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Work Email
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1. Why are you interested in becoming a board member of the Girls Coalition of MN?
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2. What specific area(s) of expertise, skill or contribution will you bring to the board?
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3. How have you been involved with issues to adolescent girls, girl advocacy or girl empowerment?
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4. GCM is committed to creating a diverse coalition that can meaningfully benefit girls of all backgrounds. What is your involvement with communities of various races or ethnicities, economic levels or sexual orientations?
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| 5. Are you currently or have you previously been involved on other Board of Directors? Yes
or No
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6. Please provide the names, professional titles and the phone numbers of two (2) references:
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7. Is there anything else that you would like for the Selection Committee to know about you?
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8. What Professional Affiliations do you belong to?
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9. Please check all that apply:
Please note: It is the policy of the Girls Coalition of Minnesota to provide for equal opportunity to participate in this organization without regard to age, race, creed, or religion, color, disability, sex, sexual orientation or national origin. The option to self-identify by race or age is voluntary. |
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