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Board Member Application

Thank you for your interest in serving on the Board of Directors of Tillie’s Safe Haven. Board service is different from general volunteering. Board members help provide organizational leadership, oversight, and strategic direction and are expected to actively participate in advancing the mission of TSH.

Prefer paper? Download the PDF All applications

Using the paper form? Fill it out and email it to tillies.safehaven@gmail.com.

This application helps us learn more about your background, experience, and interest in serving in a governance role.

Fields marked with an asterisk are required.

Contact Information

Full Name

Preferred Name

Phone

City

Interest in Board Service

Why are you interested in serving on the Board of Directors of Tillie’s Safe Haven?

Fundraising & Community Engagement

Board members may be asked to assist with fundraising, donor development, sponsorships, community outreach, and identifying potential resources for the organization.

Please describe any relevant experience, relationships, or skills you could bring in these areas.

Other Commitments

Please list any current nonprofit boards, organizations, businesses, or significant volunteer commitments that may affect your availability or create potential conflicts with TSH.

Conflict of Interest

Do you have any employment, business, family, financial, volunteer, or other relationship that could create an actual or perceived conflict of interest with Tillie’s Safe Haven?

NoYes — please explain

References

Please provide two professional, community, or volunteer references who can speak to your character, reliability, leadership, or ability to work collaboratively.

Reference 1

Name

Relationship

Phone/Email

Reference 2

Name

Relationship

Phone/Email

Additional Information

Is there anything else you would like the TSH Board to know about you or your interest in serving on the Board?

Board Member Acknowledgment

I understand that serving on the Board of Directors of Tillie’s Safe Haven is a position of responsibility. I understand that board members are expected to act in the best interests of TSH, participate actively in board activities and decision-making, maintain confidentiality, disclose potential conflicts of interest, and fulfill applicable fiduciary and legal responsibilities.

I understand that submitting this application does not guarantee appointment to the Board of Directors and that board appointments are subject to approval in accordance with TSH’s governing documents.

Full legal name (typed signature)

Typing your full legal name here serves as your signature.

Date

Filled in automatically.