Application for National Council Delegate

National Council Delegate Application

Term 2017-2020

DEADLINE: OCTOBER 15, 2016

Before completing this application, read form #1611:“Position Description — National Council Delegate.”

Name: (Mr., Ms., Mrs.)

Address:, ,

Street, City, State Zip

E-mail address(es): @;@

Phone #s: Mobile: ()-, Work: ()-, Home: ()-

How long have you been a Girl Scout? Years as a girl member;Years as an adult member

Employment:

Retired Self-employed Private Sector Public SectorHome Worker

Volunteer Organization Student Educational Institution Other: (specify)

Current Employer:

Position: , from to

Company/Organization:

Address:

Street, City, State Zip

Race: American Indian/Alaskan Native Black Caucasian

Asian or Pacific Islander Hispanic Mixed Racial Origin Other:

Age: 14-18 19-29 30-39 40-49 50-59 60 or over

Geographic Residence Location: Urban (City) Suburban Rural

NortheastNorthwestSoutheast Southwest

Religious Preference: Protestant Catholic Jewish Islamic Hindu

Buddhist American Indian Spiritual Tradition

No Preference/Other:

Have you been a delegate to Virginia Skyline’s annual meeting? Yes; No

If yes, when?

Have you served as a National Council delegate before? Yes; No

If yes, when?

Positions held in Girl Scouting (list most recent first and include experience in other councils):

What specific skills would you bring to this position?

List other professional or volunteer experiences that have prepared you to be a National Council Delegate.

Provide a brief statement indicating why you are interested in serving Girl Scouts of Virginia Skyline Council as a National Council delegate and how you perceive the function of the National Council Meeting.

The National Council Meeting is October 2-8, 2017, in Columbus, Ohio. I am available to attend the meeting on those dates and would be available to travel on October 1for a total availability of October 1-October 8, 2017. I also understand that this position is a three-year commitment for the time period January 2017 through January 2020.

I am willing to attend meetings of at least eight service units before and two decision influencing meetings after the National Council Meeting to get input on issues and report back to the volunteers on the actions taken. I am willing to attend summer trainings and meetings of the council’s delegates to study and discuss appropriate issues to ensure that I am fully prepared to represent the council. I understand that if I am elected and am then unable to attend the National Council Meeting, I will reimburse the council for the cost of any nonrefundable tickets purchased in my name.

Complete and mail to:Board Development Committee

c/o Girl Scouts of Virginia Skyline Council, Inc.

3663 Peters Creek Road NW

Roanoke, Virginia 24019

OR

1610 — 8/2016