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Name
(Required)
First
Last
Compliance & Oversight
I have read the governing bylaws
Yes
No
I have read the volunteer handbook
Yes
No
I have signed a Conflict of Interest for this calendar year
Yes
No
Board Participation
The sector I represent is:
Government
Private
Community/Head Start Policy Council
Director Emeritus
CAT Committee(s) I serve on:
Executive Committee
Personnel/Succession Committee
Finance Committee
My role on the Executive Committee has been:
Chair
Chair Elect
Past Chair
Secretary/Treasurer
Member At Large
How long have you served on the Board?
Less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
Less than 1 year
When did you join the Board?
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Year
Year
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2023
2022
2021
2020
2019
2018
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2016
2015
2014
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2012
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1923
1922
1921
1920
Household Size
1
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5
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7
8
1
How many people live in your household?
I reside in:
Columbia County
Clatsop County
Tillamook County
Skills and Experience
The skills, experience, and/or expertise I bring to the board is:
Organizational Management
Fiscal Management
Accounting
Early Childhood – Ed. & Dev.
Parent of child(ren) enrolled in Head Start
Parent of child(ren) formerly enrolled) in Head Start
Attorney (pertinent issues)
PR/Communications
Fundraising
Human Resources
Other (please identify below)
Please list other skills and expertise you bring
Add
Remove
You may add multiple rows
I have access and/or connections in the following areas
Businesses / Corporations
Politics / Government
Religious Community
Foundations
Wealthy Individuals / Donors
Grassroots Constituents
Other (please identify below)
Please list other relationships and connections you bring
Add
Remove
You may add multiple rows
Demographics
Gender
Female
Male
Trangender
My gender is not listed
Age
Under 18
18-24
25-34
35-44
45-54
55-64
65 or Above
Prefer Not to Answer
Race
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Multiple
Prefer not to answer
Education Level
High School
Associate Degree
Bachelor's Degree
Graduate or Professional Degree
Some College
Other
Prefer Not to Answer
Are you of Hispanic or Latino Descent?
Yes
No
Housing Situation
Renter – apartment
Renter – house
Owner – house
Other
Living with a disability?
Yes
No
This field is hidden when viewing the form
Income Level
< $30,000
$30,000 – $50,000
$50,000 – $75,000
$75,000 – $83,000
$83,000 – $100,000
$100,000 – $120,000
$120,000 +
Δ
March 20, 2023
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