(* Required)  
Home Information
First Name *
Last Name *
Nickname
Address *
City *
State *
Zip Code *
Phone Number
Email *
 
Business or Professional Information
Company/Organization Name
Company/Organization Address
City
State
Zip Code
Work Phone
Work Fax
Work Email
Profession
Job Title
 
How would you like us to communicate with you?
Send mail from Catholic Charities to:
  Home address
  Business address
Send email from Catholic Charities to:
  Home email address
  Business email address
 
Biographical Information
Date of Birth
Spouse's Name
Children's names and ages
 
Academic Information
Please list highschools, colleges or universities attended, year(s) graduated and degree(s) earned.
List from most recent:
 
We suggest each member committ to at least one hour of involvement per month. This committment can come in the form of attendance at the meetings, programs, volunteer opportunities or events.
Please indicate which areas you are interested in:
  Volunteer Committee
  Social/Fundraising Committee
  Membership Committee
  Faith Committee
  St. Nicholas Project Committee
 
Any additional information or non-profit organization affiliations:
 
Optional:
Please include a brief description of why you want to become a member of the Junior Board and what personal expectations you might have in joining the Junior Board.
 
  I understand the mission of and requirements of the Catholic Charities Junior Board and would like to become a member during the current 2010 appointment year.