Specialized Needs Recreation Board Committee

PROFESSIONAL DATA SHEET

 

Name:                                                                                                  Date:                                   

 

Residence Address:                                                                                                                                   

                                                                           (Street)

                                                                                                                                                                       

                                                                     (City/State/Zip)

 

Years at Current Residence:                                   In Kootenai County:                                          

 

Home Phone (___)                                                Business Phone (___)                                        

 

Mobile:                                                                  FAX:                                                                  

 

Business Address:                                                                                                                                         

 

Years at Business Address:                                    EMAIL Address:                                                

 

Brief explanation on why you would like to serve as a board member for SNR.____________________

 

                                                                                                                                                                       

 

Area(s) of Expertise:                                                                                                                                     

 

                                                                                                                                                                      

 

Experience (Please attach a resume if possible)                                                                                        

 

                                                                                                                                                                      

 

Education (Circle Highest Grade/Degree Completed)

 

Middle School          High School          AA             BA/BS          MA/MS           Ph.D.

 

Please list other certifications, awards, etc.:                                                                                               

 

                                                                                                                                                                     

 

Committees/Commissions/Boards currently serving on:                                                                           

 

Past Committees/Commissions/Boards served on:                                                                                  

 

Comments:                                                                                                                                                  

 

                                                                                                                                                                     

 

Please list any other community organization involvement:                                                                       

 

                                                                                                                                                                    

 

PLEASE ATTACH AT LEAST ONE LETTER OF RECOMMENDATION

 

                                                                                                                                                        

Signature                                                                                              Date

 

Please return to:    Angie Goucher                        Post Office Box 2451 Coeur d’Alene, Idaho  83816

                                PHONE (208) 755-6781          FAX (208) 769-2284

 

A background check is required although SNR will be responsible for this cost.