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Boys & Girls Village, Inc.
528 Wheelers Farms Road
Milford CT 06461
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Board of Directors New Member Application

Please complete the new Board Member Application in its entirety and then submit it online. 

Alternatively you can download a hard copy of the form to complete and then mail it to:
Board of Directors
c/o Dr. Steven Kant
Boys & Girls Village, Inc. 
528 Wheelers Farms Road
Milford, CT 06461

Please tell us about yourself: (* denotes required fields)

First Name *
Middle Initial
Last Name *
  Mrs.    Ms.    Dr.    Other   
Name of spouse or significant other
Preferred E-Mail Address
Home Address *
City *
State * Zip *
Business Address *
City *
State * Zip *
Phone *
Work Phone
Position / Title
Education (Please list institutions and degrees earned)

Background (Indicate areas of work and volunteer experience):

Accounting Banking
Management Psychiatry
Law Labor Relations
VolunteerServices Child Development
Investment Sales
Public Relations Personnel
Fund Raising Government
Social Work Psychology
Please list current and past civic/community volunteer service(s)

Please list interest and/or experience in working with children with psychiatric problems

Please list other information you feel would be beneficial in your nomination for service on our Board

Nominated By
Nomination Address
State Zip
Signature *
Date *
By entering my name above I agree that it acts as my online signature *
If nominated by someone other than self, has the nominee granted consent that
his/her name may be submitted? Yes No
If elected, is the nominee willing to serve? Yes No

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