STEP Board of Directors Member Application
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Organization/Affiliation (if applicable)
*
Have you or anyone in your family received services from STEP?
*
No
Yes
Are you aware of any potential conflict of interest that would impact you serving as a member of the STEP Board of Directors? (e.g., vendor, relative of employee, subcontractor)
*
No
Yes
What potential conflict of interest are you aware of?
*
Category of Service
*
Public Sector/ Elected Official or Representative: this would include any municipal, state, or federal representative of the agency’s service area (Lycoming County and Clinton County). The purposes for having elected officials serve on tripartite boards are to encourage awareness of poverty needs within the community, to encourage action by local governments, and to foster close coordination and partnership between public agencies and the eligible entities.
Low Income Representative: this would include anyone eligible for STEP services or who represents a low-income group in the STEP service area (tenant organization, PTO/PTA, Head Start Policy Council, Aging Advisory Council, etc.). This group is comprised of people who currently live in areas served by the agency so that they have a strong voice in agency governance and direction and are able to convey to those they represent the presence and significance of community action in their lives.
Private Sector/Community Group Representative: this would include anyone from a civic, religious, or educational group; anyone who is part of the private sector in the agency’s service area; and anyone who does not fall under the two categories above. Individuals from a wide variety of groups serve to reflect and involve key interests and resources within the community to guide agency actions and outcomes.
Please indicate which of the following skills or experience you possess:
*
Finance Planning/Management
Strategic Planning
Organizational Management
Public Relations/Communication
Fundraising/Fund Development
Program Management
Teaching/Education/Curriculum Development
Community/Economic Development
Attorney/Legal
Other
Please list any affiliations or organizations you belong to (for example, membership organizations, professional or civic groups, etc.)
*
What is your why? Why do you want to be a part of the STEP Board of Directors?
*
If possible, please attach a resume.
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