Board Membership Application

Dear Prospective Board Member:

DayStar Ranch, Inc. (DSRI) supports host ranches in Northern

California with the mission of empowering individuals with the
knowledge and skills needed to live healthful lives with the use of
horse activities and other horse associated services.

Our vision is that all the DSRI’s host ranches throughout Northern
California will contribute to the unity and harmony within the
community in which they service through the promotion of horse
associated programs which focuses on healing, empowering, and
strengthening the individual as well as their relationships with family,
friends, and the community-at-large.

We thank you for your interest in becoming a trusted board member

for DSRI. Enclosed is an application for you to complete and return
prior to our Annual Board Meeting, which will be held on November
14, 2009.

If you would like more information about DSRI, please visit our
website daystarranch.org or call us at 530.529.2679.

DayStar Ranch ● P.O. Box 224 ● Red Bluff CA 96080 ● (530) 529-
2679.
BOARD MEMBER APPLICATION
Name________________________________________________________ Date __________________________
Address_____________________________________________________________________________________
City_______________________________________ State___________________ Zip______________________
Home Phone_________________________ Work Phone_____________________ Cell Phone_______________

Emergency Contact Name __________________________________________ Phone______________________

SKILLS AND INTEREST (APPLICABLE TO THE BOARD POSITION)

………………………………………………………………………………………………………………..
□ management □ public relations
□ marketing □ fundraising
□ special events □ community relations
□ education □ training
□ public speaking □ lobbying

Current occupation____________________________________________________________________________

Hobbies, skills, interests

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

Previous board or committee experiences

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

Please answer the following questions:

 Will you attend regular meetings and special meetings? □ yes □ no

 Will you attend a new member orientation? □ yes □ no

 Would you consider a quarterly financial commitment of $ 25.00? □ yes □ no

AVAILABILITY
………………………………………………………………………………………………………………..
At what times are you available?

Mondays Tuesdays Wednesdays Thursdays Fridays Saturdays Sundays

AM/PM AM/PM AM/PM AM/PM AM/PM AM/PM AM/PM

DayStar Ranch ● P.O. Box 224 ● Red Bluff CA 96080 ● (530) 529-2679.
BACKGROUND VERIFICATION
………………………………………………………………………………………………………………..
Have you ever been convicted of a criminal offense? □ yes □ no
Have you ever been charged of neglect, abuse, or assault? □ yes □ no
Has your driver license ever been suspended or revoked in any state? □ yes □ no
Do you use illegal drugs? □ yes □ no
Do you have any physical limitations or are you under any course of treatment which might limit your ability to
perform certain types of work? □ yes □ no

List three names (along with their contact information) of individuals who can provide character
references. Include at least one professional reference.

Name Contact Number Relevance

__________________________ ______________________ __________________________
__________________________ ______________________ __________________________
__________________________ ______________________ __________________________

PERMISSION TO PERFORM BACKGROUND & REFERENCE CHECK

………………………………………………………………………………………………………………..
I hereby allow Daystar Ranch to perform a check of my background, including

 Criminal record
 Driving record
 Past employee/volunteer history
 Personal references
 Physician or Therapist
I understand that I do not have to agree to this background check, but that refusal to do so may exclude me from
consideration for some types of volunteer/board work.

I understand that information collected during this background check will be appropriately limited to determining
my suitability for particular types of volunteer/board work and that all such information collected during the
check will be kept confidential.

I herby also extend my permission to those individuals or organizations contracted for the purpose of this
background check to give their full and honest evaluations of my suitability of the described volunteer/board work
and such other information as they deem appropriate

Sign_______________________________________________ Date____________________________________

………………………………………………………………………………………………………………..

How did you hear about us?

 Position description  Family/Friend/Co-workers
 Advertisement  Client of Agency
 Volunteer Center/Website Posting  Employee of Agency
 Website  Other
SIGNATURE

DayStar Ranch ● P.O. Box 224 ● Red Bluff CA 96080 ● (530) 529-2679.
Print Name ______________________________________ Signature___________________________________________

DayStar Ranch ● P.O. Box 224 ● Red Bluff CA 96080 ● (530) 529-2679.
DAYSTAR RANCH CONFIDENTIALITY STATEMENT

Date_______________________

I, ________________________, agree to keep any information learned, seen or heard associated with
DayStar Ranch kept confidential. I understand that it is a violation to disclose any information
associated with DayStar Ranch, Inc. My signature indicates my understanding and agreement of the
above statements and will comply accordingly.

Print Name _________________________________

Signature _________________________________
Date _________________________________

ADMINISTRATIVE AND FUNCTIONAL STRUCTURE OF DAYSTAR RANCH, INC.

Board Although the Board of DSRI holds fiduciary responsibilities of the organization, its primary purpose is to provide counsel that
effectuates the overall management of the organization in the pursuit of achieving DSRI long term goals. It
is the Board’s responsibility to uphold the by-laws of the organization and to provide consultative support to
the establishment and maintenance of the organization’s policies and procedures.

Committees Made up of volunteers, DSRI’s committees assist the Board of DSRI in discharging its oversight
responsibilities by fulfilling its duties as assigned.

Executive Director The Executive Director manages the day to day function of DSRI while providing the Board of DSRI a report
on the progress of the organization in its endeavors to achieve it long term goal.

Host Ranches Member Host Ranches, while following DSRI’s polices and procedures offers approved equine related
services to the local community and advisory services to the Board of DSRI.

Consultants When necessary, the Board of DSRI will request the services of consultants to assist the organization and its
host ranches in the areas of: Ranch Management, Program Management (Learning and Therapeutic
Programs), Community Economic Development, and Business Development) as a part of a committee action.

FOUR KEY FUNCTIONS OF THE DAYSTAR RANCH, INC. BOARD

DSRI’s board members are expected to meet four times a year, with the expectation that board members who are constituents
of committees are expected to meet as needed. Below, is a breakdown of time as a contributing board member:

1. Financial Resource Development (50% of time and focus)

2. Strategic Leadership within the Community (25% of time and focus)
3. Governance of Host Ranch Membership (10% of time and focus)
4. Consultation to Executive Director (15% of time and focus)
ADDITIONAL INFORMATION REQUESTED

Please provide a copy of your resume and a biography that answer the following questions:

Your experience as a member of other community groups

Your definition of Equine Assisted Learning and Psychotherapy
Your life experience(s) have you had which would add to your being a member
Your reason why you want to serve on the DayStar Ranch Board
Your special interests or areas of expertise that you can offer to DayStar Ranch, Inc.

…………………………………………………………………………………………………………………….......

SUBMITTING YOUR APPLICATION

Return the requested documents to DayStar Ranch, Inc. prior to Nov 1, 2009.

DayStar Ranch
PO Box 224
Red Bluff, CA 96080

For more information call 530.529.2679 or email info@daystarranch.org

Thank you for your interest!

Sincerely,

DayStar Ranch, Inc.