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NAMI Arkansas

PROSPECTIVE BOARD MEMBER PROFILE FORM

In order to assist us in determining your qualifications and eligibility to serve as a member of the Board of Directors of NAMI Arkansas, we ask you to complete this form.  Please answer all questions as completely as possible.  Thank you.

Name _________________________________________________ Spouse, if applicable ___________________.

Home address (street, city and zip code) _________________________________________________________________________­­­­__________________

Home phone (include area code) _________________________________________________________________

Work phone & extension (include area code) _______________________________________________________

Work address (street, city and zip code) ____________________________________________________________________________________________

Name of employer _________________________________________ Your title ___________________________.

Fax # (include area code) ________________________ Mobile # (include area code) ________________________

Email address: _____________________________________________________________________________.

Member of NAMI Arkansas ?     Y     N    Name of my local support group _____________________________.

Experience (Circle where appropriate, or fill in blank where appropriate)

My educational background includes:  Some high school?     High school graduate?    Some college?  

Undergraduate college degree?   Some graduate course work?   Graduate degree or higher?   What degree in what

field?_______________________

In my career, I have the following experience:  (please list all, e.g., bookkeeping, public relations, management, etc.) _________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Please list any volunteer experience your have (include name of organization and experience) ____________________________________________________________________________________________

____________________________________________________________________________________________

I have received specialized training or experience, either in my career or in my volunteer work (indicate which), in these areas:

Fund Raising? ________________________________ Personnel/Human Resources? ___________________________  

Finances? ___________________________________Business? ____________________________________________ 

Technology?_________________________________Legal?_______________________________________________

Marketing/Public Relations?_________________________________________________________________________  

Other? (please describe) _________________________________________________________________________________­­­­­­_______________

Please explain specifics of your specialized training or experiences circled above: ____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

NAMI Experience

I serve(d) as a board member/officer of a local support group.    Y      N       

  I do volunteer work for my local support group.     Y     N

I have taken Family to Family .   Y      N      I wish to be trained to teach Family to Family.          Y     N

I have participated in a support group.      Y     N       

I have been trained to facilitate a support group.    Y      N I wish to be trained to facilitate a support group.      Y        N

I am a consumer of mental health services.    Y     N   

  I am a family member of a person with mental illness.     Y        N

I am a mental health professional.     Y      N    

I would like to discuss further my volunteer options.    Y     N

Following are some of the areas of involvement of NAMI Arkansas.  Please circle as many areas of interest as appropriate.

Affiliate Support.      Business Operations (to include finance, personnel, and business development).      By-Laws.       

Child & Adolescent.    Conference.   Education.   Forensics.   Housing.   Legislative Advocacy.    PACT.    Public Policy.       

I am available to take support and referral calls.     Y      N       If yes,  I may be contacted at  home?    Work?    Or both?

  Expectations and Responsibilities of Board Members

(to be reviewed by, and with, a member of the Nominating Committee)

I will strive to attend all board meetings and participate on one committee?   Y    N  

I will help establish the goals of NAMI Arkansas, and I will help amend the By-Laws, as needed?    Y    N    

To comply with the principals of stewardship, I will pledge an annual gift to NAMI Arkansas?    Y    N   

I will monitor all fiscal matters to promote financial stability?    Y     N      

I will learn about the organization’s mission, services, and programs, will help further NAMI Arkansas’s goals?    Y    N    

I will attend state, and special events and I will visit one support groups besides my own each year?    Y    N    

I will serve as a liaison between the state organization and NAMI, the local support groups, governmental entities, and the community?   Y      N

I will participate in special task forces and recruit volunteers, as needed?    Y    N   

I will assist in finding my own replacement for the board?    Y     N   

Estimated number of hours per week or month available to volunteer for NAMI Arkansas__________________

(Note:  this is not a commitment, but rather a planning tool)

Committee member notes: ________________________________________________________________________________________________

________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________

Signed by:___________________________________________________    Date:_______________________

                Board Candidate

Signed by:___________________________________

                 Nominating Committee Member

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