First Name:

Last Name:

Email Address:

Contact Phone Number:

Address 1:

Street:

City:

State/Province:

Zip/Postal Code:

Country:

Education Infomation

Indicate your highest qualification achieved:

Year:

Name of institution:

Employer's details

Employees title:

Employer's email:

Phone Contact:

Type of business:


Please list previous or current Board and committee that you served on (e.g. business, political, professional, recreation, religious, bank, etc):

List the name of organization(s) or company you served:

List your roles/title:

Duration of service:

Tick all that applicable below (your skills, expereince and interest)

Education & Training
Fundraising
Finance & Accounting
Administration & Management
Grant Writing
Policy Development
Nonprofit Experience
Capacity Building
Monitoring & Evaluation
Leadership Development
Coaching & Mentorship

If others please specify: