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Board of Directors Intake Form

Welcome to the PUENTE Learning Center Board of Directors. Information collected by this form is solely to verify identity, update company records, and maintain statistics on Board members. Questions about this form? Contact us at info@puente.org.

"*" indicates required fields

Contact Information

Primary Phone Type*
Alternate Phone Type
Primary Email Type*
Alternate Email Type
Primary Address*
Primary Address Type*
Alternate Address
Alternate Address Type

Demographic Information

Are you Hispanic or Latino?*
Select one or more of the following that best describe you, if applicable.*
Invitation to Self-Identify Gender Identity*
Voluntary Self-Identification of Disability*
Birth Date

Professional Affiliation

If no professional affiliation, please enter N/A or Not Applicable.
If no professional affiliation, please enter N/A or Not Applicable.
Does your employer have a matching gift program?*

Emergency Contact Information

Emergency Contact Name*

Headshot and Bio

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 512 MB.
You are invited to share a recent photo.
Accepted file types: pdf, jpg, docx, Max. file size: 512 MB.
You are invited to share your bio.

Submission

Prior to your first board meeting, PUENTE will conduct an orientation for new board members. In the meantime, is there anything else you would like to ask or let us know?
Consent*
Please type your name.
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