Placer Independent Resource Services, Inc.
( PIRS )

Application for Board of Directors

Name:

Address:

Home:

Work:

Phone: Home ()-     Work: ()-

Cell: ( )-

FAX: ()-     TDD: Yes No

E-mail Address:

Occupation:

(Please attach your resume)

Please describe your knowledge of, and experience with, Independent Livingphilosophy, disability and PIRS:

Why are you interested in serving on the Board of Directors? Please describe any special expertise or skills that would be of benefit to PIRS and its programs.:
.

Please describe your experience with advocacy activities:


Please describe your experience with fundraising activities, for example, special events, grant-writing, corporate or foundation requests, etc.

Please describe any other areas of interest you may have in addition to the information already provided.



Thank you for your interest in PIRS and your willingness to make a commitment to independent living. Directors generally work 4 - 6 hours per month in addition to fundraising activities. This includes serving on at least one committee and participating in advocacy activities.

Our goal is to create a barrier-free community where everyone has access to its services and resources and people with disabilities have all the same choices as everyone else.

PLEASE FILL OUT, PRINT AND RETURN OR MAILTHIS FORM TO:

Chair, BOARD DEVELOPMENT COMMITTEE
PIRS
11768 ATWOOD ROAD, STE. #29
AUBURN, CA 95603