Public Charter School Governing Board 
Member Information Sheet

Name of Public Charter School ____________________________________________

Name of Board Member __________________________________________________

Email Address __________________________________________________________

Occupation ____________________________________________________________

Please respond to the following questions:

1.	Why do you wish to serve on the governing board?

2.	What is your understanding of the educational needs of students in the catchment area?

3.	Please list any previous or present educational involvement; such as board member, budget committee, citizens committees, etc. List school(s) or district(s).

4.	What special qualifications do you have that will help you to be a board member?

5.	What is your understanding of the role you will play as a public charter school board member?

Sign______________________________________Date_______________________

This form MUST be submitted to the Maine Charter School Commission via Epicenter.