Application For Membership

* denotes required field

Name of Candidate *
Maiden Name
Address *
City * State * Zip *
Phone * () -
Husband's First Name
Approximate Ages of Children
Length of Residence in Chicago Area
Affiliation with Northwestern University
Other Affiliations

Background Information. Please indicate andy direct contact you may have had with the candidate, such as:

1) How long have you known the candidate? *
0/1000 characters

2) Does the candidate have a profession? If yes, what?
0/1000 characters

3) Why do you feel the candidate would be a good Board Member? *
0/1000 characters

4) List Board Meetings that the candidate has atteneded as a guest: *
0/1000 characters

5) List additional Board Members who know this candidate: *
0/1000 characters

Comments:
0/1000 characters

Proposer's Application for Membership
As proposer, I understand that it is my responsibility to integrate this candidate onto the Board by attending at least three meetings with her during her first term should she be accepted into membership.

Name of Proposer *
Name of Seconder *