Name ____________________________________ e mail _______________

Address _______________________________________________________

City, State, Zip _________________________________________________

Telephone - home _____________________ work ______________________
(Please circle preferred contact telephone number)
Employer _______________________________________________________

Position ________________________________________________________

Education: - High school graduate
(circle choice) - GED
- Some college
- Undergraduate degree – major ___________________________
- Graduate degree – major _______________________________
- Other (please specify) _________________________________

How did you hear about Literacy Volunteers? ________________________
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What other boards do you/have you served on? _______________________
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When are you available to attend meetings? _________________________
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What special skills would you bring to the board? _____________________
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What do you think you will achieve/accomplish by joining the board of LVNC?
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