FOLMC Board Intake Form

Name(Required)
Address(Required)
Gender(Required)
Answers are taken in aggregate and not shared as individual results.
Age(Required)
Answers are taken in aggregate and not shared as individual results.
Race/Ethnicity(Required)
Answers are taken in aggregate and not shared as individual results.
Sexual Orientation(Required)
Answers are taken in aggregate and not shared as individual results.
Employment Status(Required)
Answers are taken in aggregate and not shared as individual results.
Expertise/Experience(Required)
Answers are taken in aggregate and not shared as individual results.
Affiliation(Required)
Answers are taken in aggregate and not shared as individual results.
Service Region of County(Required)
Answers are taken in aggregate and not shared as individual results.
Has the Friends contracted to purchase or lease goods, services, or property from you or from any relative or business associate?
Has the Friends purchased an ownership interest in or invested in a business entity owned by you or owned by any relative or business associate?
Has the Friends offered employment to you or to any relative or business associates other than a person who was already employed by the Friends?
Have you or have any relative or business associate been provided with a gift, gratuity, or favor from a person or entity which does business or seeks to do business, with the Friends?
Have you or any relative or business associate been gratuitously provided use of the facilities, property, or services of Friends?
Did you obtain preferential treatment by the Friends for yourself or for any relative or business associate?
Did you make use of confidential information obtained from the Friends for your own benefit or for the benefit of a relative, business associate, or other organization?
Did you take advantage of an opportunity, or enable a relative, business associate or other organization to take advantage of an opportunity, which you had reason to believe would be of interest to the Friends?

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