Please enable JavaScript in your browser to complete this form. - Step 1 of 2Name *FirstLastAddress *Include Physical Address if different from Mailing AddressContact Phone Number *Email *Which jurisdiction of the New River Valley, Virginia do you reside? *Floyd CountyGiles CountyRadford CityPulaski CountyMontgomery CountyAre you a current or past recipient of one of NRCA’s services? *YesNoIf you have participated in NRCA services, which program(s)? Can you commit to attend monthly Board meetings on the third Tuesday at 7:00 PM? *YesNoNote: Board meeting attendance is critical to ensure a quorum for conduction of business and to maintain member knowledge of Board and agency operations. Can you commit to participation on a Board committee? *YesNoNote: Frequency of meetings varies; committees schedule meetings per member availability. NextCommittee PreferencePlease refer to agency bylaws for committee description details at https://newrivercommunityaction.org/board-resource-documents/ Program Planning and Evaluation CommitteeFirst ChoiceSecond ChoiceThird ChoiceFourth ChoiceFinance CommitteeFirst ChoiceSecond ChoiceThird ChoiceFourth ChoicePersonnel CommitteeFirst ChoiceSecond ChoiceThird ChoiceFourth ChoicePublic/Community Relations & Resource Development CommitteeFirst ChoiceSecond ChoiceThird ChoiceFourth ChoiceWhy are you interested in our organization and serving on this Board? *What competencies do you possess that would contribute to your effectiveness as a board member? *(What is your relevant experience and/or employment that would benefit the New River Community Action Board?) What personal qualities do you possess that would contribute to your ability to work effectively with others in furthering the mission of New River Community Action? *Disclosure of potential conflict of interest—Do you engage in activities or maintain associations that could be perceived as a conflict with your role as a Board member of New River Community Action? *YesNoIf yes, please explain.Do you have an immediate family member as defined below employed by NRCA? *YesNoFrom NRCA Personnel Policies: No person will hold a job at the agency while an immediate family member serves on an agency board, advisory board, or supervises that position. The immediate family will include any of the following: wife, husband, father, mother, brother, sister, son, daughter, grandfather/mother, in-laws and step-relatives (for those relatives noted previously above), or anyone living in the immediate household. If yes, please specify name and relationshipSubmit
