APPLICATION FOR APPOINTMENT

TO THE DISTRICT 58 BOARD OF EDUCATION

The information provided herein will be kept in confidence by the members of the
District 58 Board of Education. The person appointed will fill an unexpired term from
approximately September 2015 to April 2017.
NAME: __________________________ PHONE: (home) ___________________
(business) ________________
(cell) ______________________
ADDRESS: ____________________________________________________________
________________________________________________________________________
EDUCATION: _________________________________________________________
High School _____________________________________________________
College _________________________________________________________
Degree and Major __________________________________________
Graduate College ________________________________________________
Degree and Major __________________________________________
Other Education _________________________________________________
_________________________________________________
OCCUPATION: ________________________________________________________
Employer _____________________________________________________________
(Name)
(City)
1.

Organizations, memberships and offices held:

(Attach additional page if necessary)
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

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2.

For each child in your immediate family, indicate his/her grade in school and the
school attended. (Under GRADE, please indicate PS for preschool and HS for
high school graduate.)
GRADE

SCHOOL

_____

________________________________________________________

_____

________________________________________________________

_____

________________________________________________________

_____

________________________________________________________

3.

How many years have you lived in District 58? ___________

4.

How many school board meetings have you attended?

District 58 _________

5.

Other Districts _________

Do you have any current or potential conflicts of interest?

(Explain any YES replies.)
Relative(s) employed by District 58?
_______ Yes (Explain)

______ No

Contacts or business/professional relationships with District 58?

_______ Yes (Explain)

______ No

Other potential conflicts?

_______ Yes (Explain)
6.

______ No

List members of the District 58 administrative and teaching staff with whom you
have spoken about the District's operation (excluding topics related only to your
own children's experience).
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
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7.

What particular qualifications would you bring to the Board?

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

8.

What contributions would you hope to make as a Board Member?

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

9.

What topics in the areas of finance (expenditures and revenue), curriculum,

facilities, labor relations, staff, etc., are of special concern or interest to you?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

10. Have you read and thoughtfully considered the literature provided to you with
this questionnaire?
_____ Yes
_____ No
Board membership is a commitment of time and intellect. Board members should
be able to regularly attend two to four evening meetings per month, and be able
to respond to crisis situations that may demand their time on short notice. In
preparing for meetings, board members must devote time to reviewing
information provided by the administration, to communicating informally with
administrators and other board members, and to formulating their own
questions, concerns, and opinions.

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11.

If appointed, would you consider being a candidate for election in April 2017?
_____ Yes

_____ No

_____ Maybe

Please explain if reply is No or Maybe.

Tentative interview dates are set for Wednesday, September 9, 2015 beginning
at 7:00 p.m. If additional time is needed, interviews may also take place on
September 15, 16, & 17, 2015.

Please return application no later than 4:00 p.m., Wednesday, September 2, 2015:

District 58 Board of Education

1860 63rd Street
Downers Grove, IL 60516

Thank you.

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