Full Name of Candidate

Home Address (Street, City, Zip)

Telephone (cell, home)

Email Address

Religious affiliation/denomination

Congregational affiliation, if any

Candidate's profession

Candidate's current job title and employer

Candidate's age group

19-34 35-49 50-64 65+

Commitment to Levine Academy:

Name(s) of any child/children of Candidate that are current enrolled as students at Levine Academy

Please describe any current or past work by Candidate with Levine Academy Board of Trustees, Parents Association, committees including, but not limited to, fundraising efforts

Please describe any other connections that Candidate has to Levine Academy (consider alumni, parents/grandparents of alumni, Jewish community activists/philanthropists, Jewish educators, skilled professionals)

Commitment to Jewish and general communities (consider volunteer, civic, professional and business activities) including experience on Boards for non-profit and/or educational organizations

Personal characteristics, specialized education and/or skills (e.g., Finances, HR, Legal, Technology, Marketing, Construction, etc.) and leadership abilities of Candidate

Why do you think that this person would be an asset to the Board?

Name and contact info (email/phone) of Recommending Person (if other than self)