Application for Board Membership

Fill out the volunteer form below and a member of our staff will be in touch!

Or, you can download/print the Board Application

Name(Required)

First Last

Home Phone(Required)

Cell Phone(Required)

Address(Required)

Street Address City State ZIP Code

Email(Required)

Employer(Required)

Title(Required)

Work Address(Required)

Street Address City State ZIP Code

Work Phone(Required)

Work Email(Required)

Preferred method of contact(Required)

Home

Work

Phone

Please answer all of the following questions.

What is your interest and motivation for serving on the Board of Directors?(Required)

Briefly, outline the specific skills, experience and educational background you bring, or contributions you hope to make, to Gold Country Senior Services?(Required)

How long have you lived in Western Nevada County?(Required)

Describe your experience with community-based organizations, including boards and committees that you serve on, or have served on in the past.(Required)

In what areas might you be interested in serving?(Required)

Finance/Accounting

Personnel/Human Resources

Administration/Management

Policy Development

Program Evaluation

Public/Community Relations

Education/Instruction/Training

Special Events

Grant Writing

Fundraising

Outreach/Promotions

Other

Other areas of interest for service

Please upload any attachments

Accepted file types: jpg, jpeg, png, docx, doc, pdf, gif, Max. file size: 256 MB.

If you have completed the application and would like to upload it here you can. Otherwise, please mail it to PO Box 968, Grass Valley, CA 95945

Contact Us

Gold Country Senior Services

530-615-4541 Administration
530-273-4961 Nutrition Office

Administrative Office
206 Providence Mine Road, Suite 118
Nevada City, CA 95959

Nutrition Program
841 Old Tunnel Rd.
Grass Valley, CA 95945

Mailing Address
PO Box 968
Grass Valley, CA 95945

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