2018 Board of Directors Volunteer Application
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SECTION I: Contact Information
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SECTION II: Relationship with USA Swimming
1. Are you a current member of USA Swimming? *
2. If yes, what is your membership category?
 
3. Have you ever been a member of the USA Swimming House of Delegates? *
4. Do you have what you believe would be considered a "demonstrable connection" to swimming? *
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SECTION III: Employment Experience
5. Please list your current position and the previous three (if applicable):
 PositionEmployerDates
1
2
3
4
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SECTION IV: Background, Credentials and Professional Designations
6. Educational Degrees
 DegreeDate ReceivedCollege/Institution
1
2
3
7. Other Designations or Professional Certificates
 DesignationDate ReceivedGranting Organization
1
2
3
8. Areas of Expertise (please check all that apply) *
 
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SECTION V: Previous Volunteer Service Other Than on a Board of Directors
9. Please list previous volunteer positions held with USA Swimming or other sports/professional community organizations:
 Volunteer Position One
Organization
Service/Position Held
Dates of Service
Reference Name
Reference Phone Number
 Volunteer Position Two
Organization
Service/Position Held
Dates of Service
Reference Name
Reference Phone Number
Do You have an Additional Volunteer Position to List?
 Volunteer Position Three
Organization
Service/Position Held
Dates of Service
Reference Name
Reference Phone Number
Do You Have an Additional Volunteer Position to List?
 Volunteer Position Four
Organization
Service/Position Held
Dates of Service
Reference Name
Reference Phone Number
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SECTION VI: Previous Governing Board Experience
10. Please provide the following information for each governing Board of Directors on which you served. 
 Organization One Board of Directors Service
Organization Name
Dates of Service
Annual Organizational Budget (approximate)
Leadership Positions Held, if any, and Length of Time
 Organization Two Board of Directors Service
Organization Name
Dates of Service
Annual Organizational Budget (approximate)
Leadership Positions Held, if any, and Length of Time
Do You Have an Additional Board of Directors Service to List?
 Organization Three Board of Directors Service
Organization Name
Dates of Service
Annual Organizational Budget (approximate)
Leadership Positions Held, if any, and Length of Time
Do You Have and Additional Board of Directors Service to List?
 Organization Four Board of Directors Service
Organization Name
Dates of Service
Annual Organizational Budget (approximate)
Leadership Positions Held, if any, and Length of Time
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11. Please supply two references: Please provide contacts of individuals with whom you have worked on a board of directors (preferably) or as part of a work-group tasked with collaborative decision-making. (Note: references will not be contacted until after initial telephone interview with Nominating Committee representatives)
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SECTION VII: Personal Disclosures
12. Have you ever been convicted of, or plead guilty or nolo contendere to, a felony or crime involving embezzlement, conversion of property or moral turpitude? *
13. Have you ever been terminated from employment, or resigned to avoid termination from employment, for the commission of fraud, embezzlement, conversion of property of financial dishonesty? *
14. Have you ever been terminated from employment, or resigned to avoid termination from employment, for the abuse of alcohol or other legal substances, or the abuse of illegal substances? *
15. Is there anything in your background that if publicly highlighted, could damage the reputation or integrity of either USA Swimming or you, or make it difficult or impossible for you to fulfill your duties as a director? *
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SECTION VIII: Open-Ended Questions
22. If selected to serve, which Board Committees do you believe you would be able to make the greatest contribution to and why? (Please mark and rank, i.e. 1-6 all that apply)
 RankWhy?
Nominating
Investment
Audit
Governace
Executive Compensation
Membership Relations
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SECTION IX: Submittal and Acknowledgement
I agree that everything on and attached to this form is correct, complete and accurate to the best of my knowledge.
Signature *
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