PERSONAL INFORMATION

First Name: *

Last Name: *

Address: *

City: *

State: *

Zip code: *

Phone Number: *

Email Address: *

Birthdate *

Care to share anything about your family ? partner, children, pets (names and ages)

Were you a Girl Scout? *

As a youth

As an adult volunteer

No

My strongest personal and professional networks are located in: (Please check all that apply.) *

CHICAGO DOWNTOWN (COOK COUNTY)	CHICAGO NORTHSIDE (COOK COUNTY)	CHICAGO SOUTHSIDE (COOK COUNTY)
NORTHWEST SUBURBS (COOK, LAKE COUNTIES)	WESTERN SUBURBS (DUPAGE, WILL COUNTIES)	SOUTH SUBURBS (WILL, GRUNDY, KANKAKEE COUNTIES)
NORTHWEST INDIANA (JASPER, LAKE, NEWTON ,PORTER COUNITES) counties)	OTHER OTHER

PROFESSIONAL INFORMATION

Which of the following categories best describes the industry you primarily work? *

Employer name: *

Occupation: *

Phone number:

Email: *

Please provide any skills or expertise that would support the Girl Scouts of Greater Chicago and
Northwest Indiana council and the Girl Scout mission.
*

HOW YOU IDENTIFY ?

Race/Ethnicity *

Which age category best defines you? *

Gender Identity: *

WHY GIRL SCOUTS OF GREATER CHICAGO AND NORTHWEST INDIANA?

Why are you interested in serving on the Board of Directors for Girl Scouts of Greater Chicago
and Northwest Indiana? *

Board Directors are required to demonstrate their commitment to the Girl Scouts of Greater Chicago and Northwest Indiana through a minimum give/get contribution of $12,500 on an annual basis. Typically this is achieved through a combination of personal contribution and contributions secured from organizations and/or individuals in a Board Director's network. Please provide information regarding your potential personal giving intention as well as your access to organizations or individuals who would support Girl Scouts because of your association with the council. *

Girl Scouts of Greater Chicago and Northwest Indiana is committed to providing equity for all girls. What is your approach to Diversity, Equity and Inclusion (DEI) in your personal and professional life? *

Please share any additional information or comments for our Development Committee. *

PLEASE UPLOAD YOUR PROFILE/RESUME.

THANK YOU FOR YOUR INTEREST TO MAKE A DIFFERENCE IN THE LIFE OF A GIRL. WE WILL BE IN TOUCH.

By clicking submit, I consent to the Girl Scouts of Greater Chicago and Northwest Indiana collecting and processing my personal data.

ADVERTISING	BANKING/FINANCIAL SERVICES	CONSULTING
EDUCATION	ENERGY	HEALTHCARE
INSURANCE	LEGAL	MANUFACTURING
MARKETING/PUBLIC RELATIONS	REAL ESTATE	RETIRED
TECHNOLOGY	OTHER OTHER

AMERICAN INDIAN OR ALASKA NATIVE	ASIAN OR ASIAN AMERICAN	BLACK OR AFRICAN AMIERICAN
HISPANIC,LATINX OR SPANISH ORIGIN	MIDDLE EASTERN OR NORTH AFRICAN	NATIVE AMERICAN OR PACIFIC ISLANDER
WHITE	PREFER TO SELF DESCRIBE PREFER TO SELF DESCRIBE

UNDER 25 YEARS OLD	26-35 YEARS OLD	36- 45 YEARS OLD
46- 55 YEARS OLD	56- 65 YEARS OLD	OVER 65

WOMAN	MAN	NON-BINARY
AGENDER	GENDER FLUID	GENDER QUEER
PREFER NOT TO ANSWER	PREFER TO SELF-DESCRIBE PREFER TO SELF-DESCRIBE