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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
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