YOU THRIVE FLORIDA

LOW-INCOME SECTOR GOVERNING BOARD MEMBER APPLICATION

NAME: *

MAILING ADDRESS: *

EMAIL: *

PHONE: *

OCCUPATION: *

1) Do you recognize any potential conflict of interest (e.g.: business, personal or financial relationships with You Thrive Florida)? *

Yes

No

If yes, please contact our office at (352)796-5222.

2) Check the following county in which you reside: *

3) What is the name of the city/neighborhood in which you live? *

4) Are you able to regularly attend quarterly board meetings in person or by phone, which are held on the second Wednesday of the following months (January, April, July & October)? *

Yes

No

5) Are you able to participate and/or represent You Thrive Florida (YTF) in the following areas (please check any that apply): *

6) Describe any community activities you are/have been involved with and specifically how have you advocated for low-income people? *

7) Check the box next to the statement that best applies to you: *

I am a low-income person based on 200% of the federal poverty guidelines.

I am not a low-income person, but have a passion to represent the low-income community.

If you checked that you are low-income based on the federal poverty guidelines, please answer questions 8, 9 and 10.

8) How many people (including yourself) currently live in your home?

9) What is your total annual household income? *please note you may be asked to verify this information.

10) This is an opportunity to sell yourself to voters. Describe why you are the best person to represent your community on low-income matters:

Incomplete applications will automatically be disqualified.

Signature: *

clear

Date: * +