WIB Boardroom Ready Application
2018 Women In Bio Boardroom Ready Application
Applicant Information
Prefix: Name:
Title:
Company Name:
Home Address:
Preferred Phone:
Preferred E-mail:
Leadership Experience
Please describe below a specific experience in which you exhibited strong leadership skills. (Please limit your response to 200 words or less).
Please list below the organization and dates of any board experiences you have held (e.g. non-profit, academic, advisory, scientific, etc.).
Women In Bio Membership
Applicants must have WIB membership (individual) to apply for this program. If you need to apply or renew your membership, please go to the following link: http://womeninbio.org/membership/join-us
Please initial here to confirm you are a WIB member.
Please describe below any WIB leadership or volunteer positions you have held.
References
Please provide two references (superiors, peers) who can speak to your ability to serve on a board (e.g. your experience, leadership skills, decision making, etc.).
Name:
Position and Company:
Phone Number: Email Address:
Name:
Position and Company:
Phone Number: Email Address:
Board Interests
Please let us know your board interests and preferences. For example, what industries would you consider? Any industries you would avoid? Any preference regarding company size, public / private / family-owned companies, market cap?
Audit Committee Membership
Do you believe you have either the work experience or educational credentials to satisfy audit committee membership requirements? Yes No Unsure
Potential Conflicts of Interest
Please let us know if you have any anticipated board conflicts of interest that would directly conflict with your current assignment.
Availability
The Boardroom Ready Training in Washington D.C. will take place on September 12-14 and October 24-26, 2018. Please initial here to confirm you will be able to attend and fully participate in both sessions.
The ultimate goal of the Boardroom Ready program is to have our candidates serve on corporate boards.
· Please initial here to confirm your current employer does not prohibit board service.
· Please initial here to confirm that you have the time and interest to serve on a corporate board.
Interest
Why do you want to participate in Women in Bio’s Boardroom Ready program? (200 words or less)
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Instructions: Please submit this application with a current copy of your biography and CV to by March 15, 2018. Late applications will not be accepted.
You will be notified by July 1, 2018 regarding whether you have been accepted into the 2018 Boardroom Ready class. If selected to participate, you will be required to obtain a written approval from your CEO to support your participation in this program and to confirm you are not prohibited from board service.
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