Board Application

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Name(Required)

First Last

Email(Required)

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Mobile Phone(Required)

Work Phone(Required)

Preferred Contact Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Current Occupation(Required)

Employer(Required)

Type Of Business / Organization(Required)

List Any Current FRPN Board Members That You Know & Your Relationship To Them

Did Anyone Recommend You For Board Service?(Required)

Who Recommended You For Board Service?(Required)

What Inspires You To Serve On The FRPN Board?(Required)

Summarize Your Previous Board Service, Particularly Within Non-Profit Organizations.(Required)

Include Your Role, Responsibilities, & Key Accomplishments.

UNDERSTANDING THE FRPN MISSION: The First Responder Provider Network's Mission Is To Increase Access To And Improve The Quality Of Culturally Competent Behavioral Healthcare For First Responders. We Are Interested In Hearing Your Thoughts About The Importance Of FRPN And How We Can Continue To Meet Our Mission.(Required)

Briefly List Your Volunteer Experience(Required)

Skills / Expertise(Required)

Please Explain(Required)

Provide An Example Of A Strategic Initiative You've Led Or Contributed To, And It's Outcomes(Required)

As A Board Member It Will Be Important For You To Participate On At Least One Committee Or Lead One (Please Check All Committees That You Would be Interested In Working With:(Required)

Access and Operations

CISN/Peer Support

Clinical Care

Funding

Marketing and Outreach

Nominations

Board Services Require Dedication. (Currently Our Board Meets Every Other Week For An Hour And A Half Via MS Teams. Additional Planning Meetings Occur In Person A Couple Of Times Per Year). How Will You Prioritize Your Time To Meet The FRPN Board Expectations?(Required)

How Do You Define Success As A Board Member?(Required)

Is There Any Additional Information That You Would Like To Share To Support Your Application?(Required)

Please Attach A Current Resume Including Professional Experience, Education, Other Qualifications & At Least Two References.(Required)

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Max. file size: 100 MB.

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