Get Involved - Decatur Land Trust

Section 1: Your Contact and Demographic Information

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Mobile Phone

United States+1
United Kingdom+44
Afghanistan+93
Albania+355
Algeria+213
American Samoa+1
Andorra+376
Angola+244
Anguilla+1
Antigua & Barbuda+1
Argentina+54
Armenia+374
Aruba+297
Ascension Island+247
Australia+61
Austria+43
Azerbaijan+994
Bahamas+1
Bahrain+973
Bangladesh+880
Barbados+1
Belarus+375
Belgium+32
Belize+501
Benin+229
Bermuda+1
Bhutan+975
Bolivia+591
Bosnia & Herzegovina+387
Botswana+267
Brazil+55
British Indian Ocean Territory+246
British Virgin Islands+1
Brunei+673
Bulgaria+359
Burkina Faso+226
Burundi+257
Cambodia+855
Cameroon+237
Canada+1
Cape Verde+238
Caribbean Netherlands+599
Cayman Islands+1
Central African Republic+236
Chad+235
Chile+56
China+86
Christmas Island+61
Cocos (Keeling) Islands+61
Colombia+57
Comoros+269
Congo - Brazzaville+242
Congo - Kinshasa+243
Cook Islands+682
Costa Rica+506
Croatia+385
Cuba+53
Curaçao+599
Cyprus+357
Czechia+420
Côte d’Ivoire+225
Denmark+45
Djibouti+253
Dominica+1
Dominican Republic+1
Ecuador+593
Egypt+20
El Salvador+503
Equatorial Guinea+240
Eritrea+291
Estonia+372
Eswatini+268
Ethiopia+251
Falkland Islands+500
Faroe Islands+298
Fiji+679
Finland+358
France+33
French Guiana+594
French Polynesia+689
Gabon+241
Gambia+220
Georgia+995
Germany+49
Ghana+233
Gibraltar+350
Greece+30
Greenland+299
Grenada+1
Guadeloupe+590
Guam+1
Guatemala+502
Guernsey+44
Guinea+224
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Guyana+592
Haiti+509
Honduras+504
Hong Kong SAR China+852
Hungary+36
Iceland+354
India+91
Indonesia+62
Iran+98
Iraq+964
Ireland+353
Isle of Man+44
Israel+972
Italy+39
Jamaica+1
Japan+81
Jersey+44
Jordan+962
Kazakhstan+7
Kenya+254
Kiribati+686
Kosovo+383
Kuwait+965
Kyrgyzstan+996
Laos+856
Latvia+371
Lebanon+961
Lesotho+266
Liberia+231
Libya+218
Liechtenstein+423
Lithuania+370
Luxembourg+352
Macao SAR China+853
Madagascar+261
Malawi+265
Malaysia+60
Maldives+960
Mali+223
Malta+356
Marshall Islands+692
Martinique+596
Mauritania+222
Mauritius+230
Mayotte+262
Mexico+52
Micronesia+691
Moldova+373
Monaco+377
Mongolia+976
Montenegro+382
Montserrat+1
Morocco+212
Mozambique+258
Myanmar (Burma)+95
Namibia+264
Nauru+674
Nepal+977
Netherlands+31
New Caledonia+687
New Zealand+64
Nicaragua+505
Niger+227
Nigeria+234
Niue+683
Norfolk Island+672
North Korea+850
North Macedonia+389
Northern Mariana Islands+1
Norway+47
Oman+968
Pakistan+92
Palau+680
Palestinian Territories+970
Panama+507
Papua New Guinea+675
Paraguay+595
Peru+51
Philippines+63
Poland+48
Portugal+351
Puerto Rico+1
Qatar+974
Romania+40
Russia+7
Rwanda+250
Réunion+262
Samoa+685
San Marino+378
Saudi Arabia+966
Senegal+221
Serbia+381
Seychelles+248
Sierra Leone+232
Singapore+65
Sint Maarten+1
Slovakia+421
Slovenia+386
Solomon Islands+677
Somalia+252
South Africa+27
South Korea+82
South Sudan+211
Spain+34
Sri Lanka+94
St. Barthélemy+590
St. Helena+290
St. Kitts & Nevis+1
St. Lucia+1
St. Martin+590
St. Pierre & Miquelon+508
St. Vincent & Grenadines+1
Sudan+249
Suriname+597
Svalbard & Jan Mayen+47
Sweden+46
Switzerland+41
Syria+963
São Tomé & Príncipe+239
Taiwan+886
Tajikistan+992
Tanzania+255
Thailand+66
Timor-Leste+670
Togo+228
Tokelau+690
Tonga+676
Trinidad & Tobago+1
Tunisia+216
Turkey+90
Turkmenistan+993
Turks & Caicos Islands+1
Tuvalu+688
U.S. Virgin Islands+1
Uganda+256
Ukraine+380
United Arab Emirates+971
United Kingdom+44
United States+1
Uruguay+598
Uzbekistan+998
Vanuatu+678
Vatican City+39
Venezuela+58
Vietnam+84
Wallis & Futuna+681
Western Sahara+212
Yemen+967
Zambia+260
Zimbabwe+263
Åland Islands+358

Race & Ethnicity *

Gender Identity *

Age Range *

19-34
35-50
51-65
Over 65

Section 2: Your Background Information

Current Employment Status *

Employer Name (if employed)

Current Occupation or Professional Field

Years in your profession or current field

Please list your degrees and any professional certifications you hold (including the school)

Briefly describe your professional background

What other volunteer positions have you held?

Please provide your LinkedIN profile URL

Section 3: Mission Alignment

In what ways have you interacted with our organization before applying for the advisory board? *

Examples: committee member, housing task force, donor, ect.

Why is our mission important to you?

Why do you want to be on our community advisory board? *

Section 4: Governance

If you have served on a board before, please provide the organization name, dates of service and reason for leaving for the three most recent board positions. *

Do we have your permission to contact the organizations above to ask about your board service with them? *

Yes
No
Not Applicable

Each year, every board member is required to disclose any potential conflicts of interest associated with your service as a CAB member. Please describe any conflicts of interest you would need to disclose if selected to join the board: *

If selected to serve on the DLT Community Advisory Board, meetings are scheduled for the third Wednesday of each month 6:00pm-7:30pm. Are you available at this time? *

Note: Meeting times and days may be adjusted based on the responses collected from potential candidates.

Please check the times you are available for a virtual and/or in person board prospect meeting with the Executive Director and/or DLT Board Members: *

Tues. April 25th at 5:30pm
Tues. April 25th at 6:30pm
Tues. April 25th at 7:30pm
Weds. April 26th at 5:30pm
Wed. April 26th at 6:30pm
Wed. April 26th at 7:30pm
Sat. April 29th at 10:00am
Sat. April 29th at 11:00am
Sat. April 29th at 12:00pm

Please check no more than 3 options for your meetings time.