Attachment #14
Board of Directors Information
Agency Name: ________________________________________________________________
Total Number of Board Members: __________
Committee
Name, Address, Phone # of Board Members
Office Held
Term
Assignment(s)
Please indicate the number of Board Members who consider themselves among the following categories.
(These numbers may be duplicative.)
____ Persons Living with HIV or AIDS
____ Racial/Ethnic Minorities
____ Gay Men or Lesbians
____ IV Substance User Community
____ Clients