Www.asaging.org



[pic]

ASA Leadership Volunteer Application

|Committee Applying For | |

|Term Applying For | |

|Name | |

|Title | |

|Affiliation | |

|Address | |

|Phone | |

|Fax | |

|E-Mail | |

|ASA Member |New ____ |

| |Continuing___ How Many Years___ |

1. Please provide a short biography (200 words or less) describing your expertise and /or interest in the focus of the committee/constituent group leadership council you are applying for.

2. Candidate Profile - Self Assessment

ASA Leadership volunteers play a strategic role in service to the membership and to the organization. In order to determine how you might best be of service to ASA, please complete a self assessment, rating your skills/expertise in the following areas. Place an “X” in the box that corresponds to the score option that best defines your level of expertise for each competency:

Scores:

1 = None: not knowledgeable; no personal (first-hand) experience

2 = Fair: knowledgeable; no/little personal (first-hand) experience

3 = Good: personal (first-hand) experience; competent

4 = Excellent: personal (first-hand) experience; expert

|COMPETENCY |1 |2 |3 |4 |

|Administration/Management |  |  |  |  |

|Business/Corporate |  |  |  |  |

|Change Agent/Advocate |  |  |  |  |

|Communication Skills – Verbal |  |  |  |  |

|Communication Skills – Written |  |  |  |  |

|Conflict Resolution |  |  |  |  |

|Consensus Building |  |  |  |  |

|Finance and Budgeting |  |  |  |  |

|Financial Planning and Investments |  |  |  |  |

|Fund Raising |  |  |  |  |

|Governance |  |  |  |  |

|Legislative/Advocacy |  |  |  |  |

|Marketing |  |  |  |  |

|Mentoring |  |  |  |  |

|Negotiation |  |  |  |  |

|Public Relations |  |  |  |  |

|Public Speaking (conferences, media, etc.) |  |  |  |  |

|Preparing/Presenting Testimony |  |  |  |  |

|Problem-Solving |  |  |  |  |

|Professional Development/Training |  |  |  |  |

|Project Management |  |  |  |  |

|Strategic Planning |  |  |  |  |

|Working in teams |  |  |  |  |

|Team building |  |  |  |  |

|Volunteer/Staff Relations |  |  |  |  |

|Ability to recruit people of diverse backgrounds to fill ASA Leadership |  |  |  |  |

|positions | | | | |

3. ASA is committed to ensuring diversity of its leadership, as a reflection of its diverse membership. ASA seeks board volunteer leadership with diverse backgrounds, experiences and perspectives reflecting the full diversity of our economy and society. Please place a checkmark(s) below where applicable (OPTIONAL):

African American

American Indian/Alaska Native Tribal Affiliation      

Asian

Pacific Islander

Hispanic

Caucasian

Multi-racial

Other, specify     

Do you self-identify as lesbian, gay, bisexual, or transgender? (OPTIONAL)

Yes No

4. Please refer to the Board Operating Manual for duties and responsibilities of ASA Standing Committees.

| |

I agree to fulfill the obligations of the Board Standing Committee member, as outlined in ASA Board Operating Manual.

Signature

| |

Date

| |

Please return your completed form to alesias@ or fax to (415) 974-0300

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download