Prospective Board Member Nomination Form

A diverse, engaged and dynamic board is vital to achieving our vision of a just and vibrant Ohio through impactful philanthropy. The Philanthropy Ohio Board of Trustees is seeking additional trustees who represent the membership in all its diversity, and greatly appreciate your serious consideration.

Please submit the below nomination form by Monday, August 11. For questions, contact Board Governance Committee Chair Brian Wagner.

Nominator's Information

Name

Phone

Nominee Information

Nominee Name

Nominee Title

Nominee Organization

Nominee Email

Nominee Phone Number

Areas of Expertise

	What is this person’s top three areas of expertise?
Development/Fundraising	Development/Fundraising
Diversity/Equity/Inclusion	Diversity/Equity/Inclusion
Foundation Leader	Foundation Leader
Governance	Governance
Investment/Finance/Audit	Investment/Finance/Audit
Legal	Legal
Marketing/Communications	Marketing/Communications
Programs/Learning/Education	Programs/Learning/Education
Public Policy	Public Policy
Strategic Planning	Strategic Planning

Demographics

	Geographic region represented:
Central	Central
Northeast	Northeast
Northwest	Northwest
Southeast	Southeast
Southwest	Southwest

	Funder type:
Community Foundation	Community Foundation
Corporate Foundation	Corporate Foundation
Private/Family Foundation	Private/Family Foundation
United Way	United Way
Other	Other

	Gender:
Female	Female
Male	Male
Non-binary/third gender	Non-binary/third gender
Other	Other

	Race/ethnicity (select all that apply)
Asian/Pacific Islander	Asian/Pacific Islander
Bi/Multi-racial	Bi/Multi-racial
Black/African American	Black/African American
Latinx/Hispanic	Latinx/Hispanic
Middle Eastern or North African	Middle Eastern or North African
Native American/American Indian	Native American/American Indian
White	White
Decline to answer	Decline to answer

	Age:
Under 40	Under 40
41-60	41-60
Over 60	Over 60

Leadership Experience

Describe level, depth and breadth as well as sphere of influence:

Notable accomplishments:

Personal skills, characteristics and interests

Engagement in Philanthropy Ohio:

Other board experience/other affiliations:

Other reasons for referral:

Education: