Board Member Application - Dinner Program

Thank you for your interest in becoming a Board Member of the Sacred Heart Dinner Program. Please complete this
application and email it to shdinnerprogram@gmail.com ,bring it to the Rectory, or mail it to: Sacred Heart Dinner
Program, 3211 Sacred Heart Way, Washington DC 20010.
Last Name

First Name

Address

Middle Name

City

Daytime Phone
Address

State

Evening Phone

Zip Code

Cell Phone

Email

How did you learn about the Dinner Program?

Mass

Website

Church Bulletin

Event

Other
Are you able to commit to board membership for at least one two-year term?
Yes
Are you willing to attend quarterly and special meetings?
Yes
No
Are you a member of any other board(s)?
Yes
No

1.

On the back of this application, please answer the following questions.

Why do you want to become a board member?

2.

What special skills would you bring to the board?

Please list three references that can attest to your character, skills, and dependability.
1.
2.

3.

No

Certification To complete the application process, please read and sign below.

I understand that this is an application for and not a commitment or promise of board
membership. I certify that I have provided information on this application for a board
position at Shrine of the Sacred
Heart Dinner Program that is true, correct, and complete to the best of my knowledge. I
understand that misstatements or omissions of information on this form may delay or revoke
board membership.
Print Name:

___________________________________________

Signature: ____________________________________________________
________________________________
Question 1 Why do you want to become a board member?

Question 2 What special skills would you bring to the board?

Date:

Thank you for completing this application!