*1.Are you currently a KCSEA member?(Required.)

Yes

No

*2.What is your name?(Required.)

*3.What is your work title?(Required.)

*4.What agency/company/organization are you employed by?(Required.)

*5.What is your address?(Required.)

*6.What city/town do your reside in?(Required.)

*7.What state do you reside in?(Required.)

*8.What is your zip code?(Required.)

*9.What is your email address?(Required.)

*10.What is your phone number?(Required.)

*11.How long have you been in your current position?(Required.)

*12.Provide a description of your job as it relates to child support. Include prior experience/employment.(Required.)

*13.Do you have previous experience with KCSEA as a director, officer, committee chair/co-chair or committee member?(Required.)

*14.Do you have the approval/support of your supervisor or manager for the commitment required to be a Board of Director? (Four in-person meetings a year in Topeka approximately 3 – 4 hours each and a monthly virtual meeting approximately one hour each. These do not include committee meetings and/or committee work.)(Required.)

Yes

No

*15.List other volunteer positions you have held, including your role and name of the organization.(Required.)

*16.Are there special ideas and/or issues you want to bring to the KCSEA leadership?(Required.)

*17.What contributions or skills do you feel you can bring to the KCSEA Board as a Director?(Required.)