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Part I: Personal Information

Name

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Layout

Primary Phone

Professional Email

Employer

Alternate Phone

Occupation

Part II: Relevant Experience and Affiliations

Please list any of your professional experiences and organizational affiliations (including director and advisory positions) that are applicable to the Director position.

Part III: Candidate Statement

Why do you wish to serve as a Meridian Director?

Part IV: Additional Information

Please upload a recent resume or C.V.

Click or drag a file to this area to upload.

Part V: Verification

Have you reviewed the Call for Candidates Roles and Responsibilities document?

Board Call For Candidates

I authorize Meridian Cooperative, Inc. to verify all information included in this application. I certify that the information contained in this application is true and accurate to the best of my knowledge and belief. I agree that if am selected for the Director position, I will comply with all Meridian Bylaws and policies applicable to the position.