Volunteer Application

To ensure proper consideration, please fill in the information below as completely and accurately as possible.

Personal Information

Volunteer Interest: *

West CAP Low Income Board of Director Election Nomination

West CAP conducts Low Income Board Member Elections every 4 years. We are seeking nominations from each county served. This is an excellent opportunity to assist our organization with developing programs that meet the needs of the community as well as gain personal/professional experience as a Board of Directors member. West CAP, (West Central Wisconsin Community Action Agency, Inc.) founded in 1965, operates a number of federal, state and locally funded programs designed to assist low-income people increase their self-reliance.

First Name *

Last Name *

MI

Address 1 *

Address 2

City *

State *

Zip Code *

County *

Birthdate:

Daytime or Work Phone *

Evening or Home Phone

Email Address *

Income Eligibility: I self attest that my household annual income is at or below 80% of my county median. See chart below. *

Yes

No

Please describe why you are interested and qualified for West CAP's Low Income Board position? *

Please describe what are the most important low-income issues you think need to be addressed by West CAP in our seven county service area (Barron, Chippewa, Dunn, Pierce, Pepin, Polk, & St. Croix)? *

Please share your experience serving on other organizations (church groups, Head Start, school, work groups, etc..)? *