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Minds Matter Chicago Board Application
First Name
Last Name
Personal email
Cell number
Mailing Address
Mailing City
Mailing State
Mailing Zip Code
Birthdate
MM/DD/YYYY
Partner's name (if applicable)
Race
Please select...
American Indian, First Nations, or Alaska Native
Bi- or Multiracial
Black, Afro-Caribbean, or African-American
East or Southeast Asian
Latine (Mexican, Central or South American, Caribbean) Indigenous
Middle Eastern or Arab American
Native Hawaiian or other Pacific Islander
South Asian
White or European
Another race
Please tell us your race
Are you Hispanic or Latino/Latina/Latine?
Please select...
Yes
No
Please list any language besides English that you speak fluently
Gender Identity
Please select...
Female
Male
Non-binary
Other (Agender, Genderfluid, Gender non-conforming, Genderqueer, or other)
Please tell us your gender identity
Pronouns
Please select...
He/Him
He/They
She/Her
She/They
They/Them
Other pronouns
Please tell us your pronouns
Undergraduate school
If your school is not listed, select "Other College/University"
Other School
Undergrad field of study
Graduate school
Graduate degree obtained
Were you a first-generation college graduate?
Please select...
Yes
No
Minds Matter defines you as a first-generation college graduate if your parents did not graduate from a 4-year college in the United States.
Company name
Type of business
Position/Title
Work email
Work phone
Work Address
Work City
Work State
Work Zip Code
Assistant's name
Preferred method of communication
Please select...
Personal email
Personal phone
Work email
Work phone
Does your company match?
Please select...
Yes
No
I don't know
Past work history (5 years)
Please provide a short biography (250 character count):
How did you hear about MMC?
Why are you interested in applying to be on the board of MMC?
What is your experience in dealing with the education sector, social justice issues or Equity Diversity & Inclusion?
Do you have any other experience you deem particularly compelling and relevant to MMC?
Write N/A if no
List former involvement -- roles and years -- with other MM Chapters (where applicable)
Is there anything else that we should know about you that would be a conflict of interest to MMC?
Select any skills/experience:
Please select...
Accounting
Administration
Budgeting
Business Management
Charitable Giving
Content
Consulting
Corporate Involvement/Giving
Data Management/Strategy
Education
Finance
Financial Modeling
Fundraising
Graphic Design
Legal
Marketing/Comm
Medical/Health
Planning
Political/Government
Public Relations
Small Business
Social/Community Connections
Social Services
Strategy/Operations
Technology
Union Labor
Other skills not listed above
Please list your current and past board experiences
Company/Organization #1
Membership dates
Leadership positions held
Reason for leaving
Company/Organization #2
Membership dates
Leadership positions held
Reason for leaving
Please list two references
Name #1
Email
Phone
Relationship
Name #2
Email
Phone
Relationship
I hereby grant Minds Matter the absolute and irrevocable right and unrestricted permission to publish, distribute, exhibit or otherwise use the photographs that Minds Matter has taken or may take of me. I understand that the images may be modified in any manner, and I hereby waive any right to inspect or approve any final product or publication that uses such photographs. I acknowledge that the images may be used in any manner, without limitations, including in print publications, online publications, websites and on social media. I waive any right to royalties or other compensation arising from or related to the use of the photographs taken of me.
Digital signature
Date
MM/DD/YYYY
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