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WE'RE HERE FOR YOU 24/7. SUICIDE PREVENTION AND 2-1-1/ Youth Crisis Mobile Response:

Prospective Board Member Interest Form

Thank you for your interest in serving on HeartLine's board. Please fill out the below form completely and accurately.

Please select one or more that apply
Please select as many as apply.
Please explain your professional experience, indicating if you have worked for nonprofit organizations, the government and/or for-profit businesses.
Please list any education and professional licenses or certifications.
Please list any community affiliations.
Please list other board, committee and volunteer experience.
Please provide any other relevant background information you would like us to know.
Please indicate which committee(s) you are interested in serving on:
Please indicate your past giving and access to resources, such as facilities, people, financial and in-kind donations.
Please tell us how you came to learn about HeartLine and why you are interested in serving on the board.
Fields with a * are required