BOARD OF DIRECTORS APPLICATION

Full Name:

Address:

City/State/Zip:

Phone Number:

E-mail:

Do you have experience serving on other boards? Yes No

If yes, what other boards do you currently serve on?

If you do have experience on a board, what committees have you participated in?

Have you participated in any other board activities besides board meetings? Yes No

If yes, what?

The Mosaic Theatre Board meets nine times a year for approximately 90 minutes. Each Mosaic Theatre board member is also required to serve on a committee and make an annual donation to the theater. Are you able to commit this amount of time to meetings, contribute personally to the nonprofit organization, and to commit to the other work necessary in governing this organization? Yes No

If yes, which committee do you feel you could best serve? Select Committee Finance Board Development and Nominating PR and Marketing Programs and Events Fundraising and Development

Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports. Please email your resume to rsimon@mosaictheatre.com

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a Board Member of Mosaic Theatre, any false statements, omissions, or other misrepresentations made by me on this application may result in immediate dismissal.

Signature:

Date: