2025 Governance Interest/Application Form

2025 Governance Interest/Application Form

This form is a tool that helps the Board Development Committee (BDC) to conduct an interview for committee or board service. The BDC must receive completed applications by 5 p.m. on December 31, 2024 for governance year May 1, 2025 - April 30, 2026
Name*

First NameLast Name
County of Residence*
To ensure we are representing all of the girls in our 8-county footprint and have an array of skills and industries represented in our governance, we ask several demographic and career questions. Thank you for completing this section as it is an important part of our Board Development Committee process.
Gender*

MaleFemaleI choose not to shareOther
Race (Check all that apply):*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteI choose not to shareOther
Ethnicity*

Hispanic or LatinoNot Hispanic or LatinoI choose not to share
Prior Relationship to Girl Scouts
Current Employer:
Position:
Skills/Industry (Check all that apply):

Community RelationshipsFinanceGovernment Relations/AdvocacyFundraising ExperienceHuman ResourcesLegalMarketing and BrandMedia/Public RelationsRisk ManagementStrategic PlanningTechnologyOther
Preferred Phone Number*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Explain your desire to serve the Girl Scout Mission.*
What is your experience serving on Governance related committees and/or boards?*

Which Governance opportunities interest you?*

	First Choice	Second Choice	Third Choice
Board of Directors (Elected Position)
Board Development Committee (Elected Position)
Finance Committee
Mission Advancement Committee
Properties Committee

What experience do you hope to gain?*
Relevant education and experience including any connections you have currently or have had to Girl Scouts:*
Please list any civic activities, professional organizations, and current Boards and/or Committees:*
What unique value, influence or perspective would you bring to the Girl Scouts of West Central Florida Board of Directors?*
Commitment:

Serving on the Board of Directors and/or committees may require a monthly meeting and a minimum of 4 significant Girl Scout events per year.
Are you willing to make the requisite time commitment to the Board or selected Committee at this time?*

YesNo
If you serve on our governance, we expect you will choose Girl Scouts of West Central Florida as one of your charity of choices. If you are a Board Member you are required to donate a minimum pledge of $1,000 per year and secure a minimum of $500 donation from others per year. Are you willing to make the requisite pledge?*

YesNoN/A (this is not required for committee members)
Please share your LinkedIn Profile here (or write N/A): *
Upon signing this application, I am acknowledging that I have been informed that if nominated and accepted, I will play a key role in building the culture of leadership and in supporting the development efforts of the organization. I understand that if nominated and accepted as a board member, I will be carrying out a governance functions as a fiduciary on the organization’s behalf. This role will subject me to three obligations:

Duty of Care requires that directors act in a reasonable and informed manner using the same degree of care as a prudent person would under similar circumstances

Duty of Loyalty requires that directors place the organizations interest above their own personal interests

Duty of Obedience requires that directors be faithful to the organization’s missions

I understand that this interest form does not constitute a nomination or acceptance and that there will be additional interview and vetting process by the Board Development Committees. As a federated organization with local delegates, Board Members and Board Development Committee Members are slated by the Board of Directors for service and elected during our Annual Meeting in April. Per our Bylaws, slated candidates may not be elected if the delegate body does not approve the slate. Thank you for your understanding of our membership-driven, democratic process. This process is not necessary for service on our committees, with the exception of the Board Development Committee. Committee Chairs and Committee Members are recommended by the Board Development Committee and approved by the Board President and Board.

If elected, I agree to serve in a strictly volunteer (no pay) capacity. I understand this role will necessitate my attendance to both Committee meetings and Board meetings, in addition to other occasional events pertinent to the fulfillment of a Board of Directors’ responsibilities.
Signature

Clear
Should be Empty:

2025 Governance Interest/Application Form

Commitment: