Date MM slash DD slash YYYY Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmail Employer NameJob TitleNumber of Years With EmployerBusiness Email AddressPlease list your affilliations with local churches, businesses, clubs, and organizationsAre you currently or have you ever served on a Board of Directors? Yes No Skills and Experience Fundraising / Donor Development Finance / Budgeting Legal / Compliance Marketing / Communications Event Planning Nonprofit Governance Construction / Handyman Skills Counseling / Recovery Support Community Outreach / Networking Other - Please specify at the end of this application Why are you interested in serving on the Board of Directors for Next Steps The Colony?What skills, experiences, or connections do you bring that would strengthen the mission of NSTC?Board members are expected to participate in fundraising, attend events, and contribute financially at a level meaningful to them (a 'get/give' expectation). How do you see yourself contributing in these areas?Serving on the Board requires an average of 4–6 hours per month. Are you able to commit this time to meetings, events, and committee work? Yes No Demographic Information (This information is periodically required for grant applications. Completion is optional and confidential.)Age Range Under 18 18-24 25-34 35-44 45-54 55-64 65 or Above Prefer Not to Answer Race I identify my race as... American Indian/Alaskan Native Asian Black/African American Mixed Race Native Hawaiian or Other Pacific Islander White/Caucasian Prefer Not To Answer Ethnicity Asian Black/African Caucasian Hispainic/Latino Native American Pacific Islander Prefer not to answer Gender Male Female Non-binary Agender My gender is not listed Prefer not to answer Equity Statement I agree to the equity statement.Next Steps The Colony sees every person as unique and worthy. We do not discriminate or tolerate harassment of any person based on race, color, religion, national origin, citizenship, age, sex, sexual orientation, gender identity or expression, disability, veteran status, marital or parental status, or pregnancy. This policy applies to participation in all Next Steps programs and events; application for employment or volunteer positions; retention and promotion of employees, volunteers, and board members; hiring of vendors and other service providers.Participation I agree to the participation policy.If I am nominated as a Board Member of Next Steps The Colony, I commit to: - Support and promote the mission of NSTC. - Attend and actively participate in board meetings and events. - Serve on at least one committee or project team. - Make an annual financial contribution at a personally significant level ('get/give' expectation). - Use my skills, resources, and network to advance the mission of NSTC.Signature