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If you are interested in joining the Junior Board, please print or download form, fill it out and return it to the YWCA of Central Virginia 626 Church Street Lynchburg, VA  24504 or email to jlodgeywca@yahoo.com or tmillerywca@yahoo.com.


Thank you for your interest!


YWCA of Central Virginia 

JUNIOR BOARD OF DIRECTORS APPLICATION 

  

         Date: __________________ 

Position Applying for:     

!  President  !  Treasurer   !  Self-Referred 

!  Vice President !  At-large member  !  Referred by ______________________ 

!  Secretary 

 

PERSONAL INFORMATION 

Name: _________________________________________ Phone: _______________________ 

Address: _____________________________________________________________________ 

Email: _______________________________________________________________________ 

 

Highest Level of Education:   

! Currently in high school 

! High school 

!  Some college 

! College Graduate 

Age Category:   

! 16-18 – high school 

! 19-25 – college student 

!  19-25 – community professional 

 

Race:   

!  African American 

! Asian 

! Caucasian 

! Hispanic/Latino 

! Native American 

! Other: _______________________ 

 

 

PROFESSIONAL INFORMATION (if currently employed): 

Name of Employer: ______________________________ Phone: _______________________ 

Address: _____________________________________________________________________ 

Position: _____________________________________________________________________ 

Supervisor: ___________________________________________________________________ 

Briefly describe your job responsibilities: __________________________________________ 

______________________________________________________________________________ 

 

STUDENT INFORMATION (if currently enrolled): 

Name of School/University: ______________________________________________________ 

Address: _____________________________________________________________________ 

Guidance Counselor/Academic Advisor: ___________________________________________ 

Phone: __________________________________  Fax: ________________________________ 

 

COMMUNITY INVOLVEMENT (List all current and previous community service): 

 

______________________________________________________________________________ 

Organization     Duties                                    Time Period Involved 

 

______________________________________________________________________________ 

Organization     Duties                                    Time Period Involved 

 

______________________________________________________________________________ 

Organization     Duties                                    Time Period Involved 

 

______________________________________________________________________________ 

Organization     Duties                                    Time Period Involved 

 

Current volunteer hours per month: ______ 

 

ESSAY QUESTIONS (attach additional sheet if necessary):   

 

1.  Describe your previous/current volunteer experience and/or accomplishments. 

______________________________________________________________________________ 

______________________________________________________________________________ 

______________________________________________________________________________ 

______________________________________________________________________________ 

______________________________________________________________________________ 

______________________________________________________________________________ 

 

2.  Describe your short-term and long-term goals. 

______________________________________________________________________________ 

______________________________________________________________________________ 

______________________________________________________________________________ 

______________________________________________________________________________ 

______________________________________________________________________________ 

______________________________________________________________________________ 

 

 

 

 

 

3.  How do you feel board service will benefit your future goals? 

______________________________________________________________________________ 

______________________________________________________________________________ 

______________________________________________________________________________ 

______________________________________________________________________________ 

______________________________________________________________________________ 

______________________________________________________________________________ 

REFERENCES

Please provide three references including one from a non-profit organization. 

 

______________________________________________________________________________ 

Name   Organization   Phone              Relationship to Applicant 

 

______________________________________________________________________________ 

Name   Organization   Phone              Relationship to Applicant 

 

______________________________________________________________________________ 

Name   Organization   Phone              Relationship to Applicant 

 

CERTIFICATION

I hereby certify that all information is true and complete, and I agree and understand that any 

falsification of information herein, regardless of time of discovery, may cause forfeiture on my 

part to any future YWCA Board service or involvement. I understand that all information on this 

application is subject to verification and I consent to references, employer, and educational 

institution listed being contacted regarding this application.  I also understand that all 

information provided in this application is used to select a diverse group of young women, 

regardless of age, race or background. 

 

__________________________________________                              _____________________ 

Signature                  Date 

 

______________________________________________________________ 

Printed Name 

 

 
YWCA Central Virginia • 626 Church Street • Lynchburg, VA 24504
email: 
ywcacentralvirginia@ywconnect.org • Phone: 434-847-7751 • Fax: 434-528-3449
Copyright 2012