JL Junior League of
Evansville

Outside Board Representative Request

Applicant/Agency/Organization Name

Name of contact person

Phone number

Email address of contact

Organization address

Is your organization a 501C3? Select ... Yes No

Nonprofit goals and/or purpose

Comminity issue addressed by your nonprofit organization:

Population served by your organization:

Job description of the position you are filling:

Proposed responsibilities of individual needed:

Meeting time and frequency:

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