Delhi Campus Child Care Center Board of Directors Application

Statement of Confidentiality: Information supplied by candidates will only be used by the Board Development Committee for the purposes of screening applicants.

1Part I- Personal Information > 2Part II-Expertise, Knowledge, Skills, and Experience > 3Part III-Board Information
Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone (home) Phone (home) - ### - ### ####
Phone (work) Phone (work) - ### - ### ####
Phone (cell) Phone (cell) - ### - ### ####
Email
Are you a NYS employee?

Are you a NYS employee? Yes No
Union Affiliation

Union Affiliation CSEA UUP PEF GSEU NYSCOPBA M/C DC37 Not Applicable Other Other
Current/Former Employer's Name
Title
Check if any of the below apply to you

Check if any of the below apply to you Currently have a child attending the Center Have had a child in the past attending the Center Plan to enroll a child in the Center in the future Never had and never will have a child enrolled at the Center
Education Background and Professional Experience