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ACGC Board Application

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For Services 512-451-2242

Contact and Background Information

First Name

Last Name

Current Employer

Title

Ethnicity

Address

City

State

Zip

Email

Mobile Phone

Work Phone

Preferred Method of Contact

Work Phone
Text
Email

Experience and Skillsets

I would bring experience/knowledge in the following areas to the Board of Directors.

I have served on the following nonprofit and/or for profit boards (include dates of service).

I participate in or volunteer for the following organizations (please describe).

Personal Commitment

Board Members are expected to actively participate in fundraising activities for ACGC. This includes becoming an individual donor of a gift that's personally meaningful to you and a willingness to leverage your personal network to support ACGC’s work.

Would this be possible for you?

Yes
No

The Board meets monthly in person for one hour during the lunch hour on a business day (currently the last Wednesday of the month).

Can you commit to attending a minimum of 9 of the 12 Board of Director meetings and two annual Board retreats?

Yes
No

All Board members are expected to serve on at least one committee. Committees meet virtually once per month.

What committee(s) are you interested in serving?

Executive Committee
Development Committee
Finance Committee
Governance Committee
Outreach Committee
Programs Committee
Technology Committee

Statement of Interest

Tell us why you are interested in serving on the Board of Directors of Austin Child Guidance Center?

What else should we know about you?

References

Please include the name, phone number and email address of both a personal and professional reference and explain your relationship with that person.

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Please include the name, phone number and email address of both a personal and professional reference and explain your relationship with that person.

Please upload your resume or a short biography if you don't have a resume available.

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The information contained in this form and attachment will be used solely by the Austin Child Guidance Center and will not be released or disclosed to any other agency or individual.

City Of Austin

City Of Austin
State Of Texas
Travis County

Travis County
St. David's Foundation
WoodNext Foundation
Michael and Susan Dell Foundation
HEB Tournament of Champions

Our Location

Call for Services: (512) 451-2242

Fax: (512) 454-9204

Contact Us

810 W. 45th Street Austin, TX 78751

Hours of Operation
Monday to Friday — 11:00 a.m. to 7:00 p.m.
Saturday and Sunday — Closed.

About Austin Child Guidance Center

Since 1951, Austin Child Guidance Center, a 501(c)(3) nonprofit organization, has been dedicated to making high-quality mental health care accessible for children and their families.

Notice Of Language Assistance:

English

English

ACA Section 1557 Notice of Language Assistance and Nondiscrimination Statement
ATTENTION: Language assistance services, free of charge, are available to you. Call (512) 451-2242
Discrimination is Against the Law
Austin Child Guidance Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Austin Child Guidance Center does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Austin Child Guidance Center provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats).
Austin Child Guidance Center provides free language services to people whose primary language is not English, which, depending on the circumstances, may include qualified interpreters and information written in other languages.
If you believe that Austin Child Guidance Center has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
ACA Compliance Officer
810 W 45th St.
Austin, TX 78751
512-451-2242 (p)
512-454-9204(f)
You can file a grievance in person, by mail, or fax. If you need help filing a grievance, Agustina Ponce is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Spanish

Spanish

ACA sección 1557
Notificación de asistencia con el idioma y declaración de no discriminación
ATENCIÓN: Usted tiene a su disposición los servicios de asistencia con el idioma sin cargo. Llame al 512-451-2242
La discriminación es ilegal
Austin Child Guidance Center cumple con las leyes federales de derechos civiles correspondientes y no discrimina en función de raza, color, nacionalidad, edad, discapacidad o sexo.
Austin Child Guidance Center no excluye a personas ni las trata de manera diferente debido a de raza, color, nacionalidad, edad, discapacidad o sexo.
Austin Child Guidance Center brinda ayuda y servicios gratuitos a las personas con discapacidades para que se puedan comunicar eficazmente con nosotros, tales como intérpretes de lenguaje de señas calificados e información escrita en otros formatos (letra grande, audio, formatos electrónicos accesibles, otros formatos).
Austin Child Guidance Center brinda servicio de idiomas gratuito a personas cuyo idioma principal no es el inglés, que, dependiendo de las circunstancias, pueden incluir intérpretes calificados e información escrita en otros idiomas.
Si piensa que Austin Child Guidance Center no le ha ofrecido estos servicios o ha discriminado de alguna otra manera en función de su raza, color, nacionalidad, edad, discapacidad o sexo, usted puede presentar una queja ante:
ACA Compliance Officer
810 W 45th St.
Austin, TX 78751
512-451-2242 (tel)
512-454-9204 (fax)
Usted puede presentar una queja de derechos civiles al Departamento de Salud y Servicios Humanos de los Estados Unidos, Oficina de Derechos Civiles, electrónicamente a través del portal de quejas de la Oficina de Derechos Civiles en
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, o por correo o teléfono al:
U.S. Department and Health and Human Services
200 Independence Avenue, SW.
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Los formularios de quejas se encuentran disponibles en
http://www.hhs.gov/ocr/pffice/file/index.html.

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Privacy Policy

Privacy Policy

What Information Do We Collect? When you visit our website you may provide us with two types of information: personal information you knowingly choose to disclose that is collected on an individual basis and website use information collected on an aggregate basis as you and others browse our website.
Personal Information You Choose to Provide We may request that you voluntarily supply us with personal information, including your email address, postal address, home or work telephone number and other personal information for such purposes as correspondence, placing an order, requesting an estimate, or participating in online surveys. If you choose to correspond with us through email, we may retain the content of your email messages together with your email address and our responses. We provide the same protections for these electronic communications that we employ in the maintenance of information received by mail and telephone.
Website Use Information Similar to other websites, our site may utilize a standard technology called "cookies" (see explanation below, "What Are Cookies?") and web server logs to collect information about how our website is used. Information gathered through cookies and server logs may include the date and time of visits, the pages viewed, time spent at our website, and the sites visited just before and just after ours. This information is collected on an aggregate basis. None of this information is associated with you as an individual.
How Do We Use the Information That You Provide to Us? Broadly speaking, we use personal information for purposes of administering our business activities, providing service and support and making available other products and services to our customers and prospective customers. Occasionally, we may also use the information we collect to notify you about important changes to our website, new services and special offers we think you will find valuable. The lists used to send you product and service offers are developed and managed under our traditional standards designed to safeguard the security and privacy of all personal information provided by our users. You may at any time to notify us of your desire not to receive these offers.
What Are Cookies? Cookies are a feature of web browser software that allows web servers to recognize the computer used to access a website. Cookies are small pieces of data that are stored by a user's web browser on the user's hard drive. Cookies can remember what information a user accesses on one web page to simplify subsequent interactions with that website by the same user or to use the information to streamline the user's transactions on related web pages. This makes it easier for a user to move from web page to web page and to complete commercial transactions over the Internet. Cookies should make your online experience easier and more personalized.
How Do We Use Information Collected From Cookies? We use website browser software tools such as cookies and web server logs to gather information about our website users' browsing activities, in order to constantly improve our website and better serve our users. This information assists us to design and arrange our web pages in the most user-friendly manner and to continually improve our website to better meet the needs of our users and prospective users. Cookies help us collect important business and technical statistics. The information in the cookies lets us trace the paths followed by users to our website as they move from one page to another. Web server logs allow us to count how many people visit our website and evaluate our website's visitor capacity. We do not use these technologies to capture your individual email address or any personally identifying information about you.
Notice of New Services and Changes Occasionally, we may use the information we collect to notify you about important changes to our website, new services and special offers we think you will find valuable. As a user of our website, you will be given the opportunity to notify us of your desire not to receive these offers by clicking on a response box when you receive such an offer or by sending us an email request.
How Do We Secure Information Transmissions? When you send confidential personal information to us on our website, a secure server software which we have licensed encrypts all information you input before it is sent to us. The information is scrambled en route and decoded once it reaches our website. Other email that you may send to us may not be secure unless we advise you that security measures will be in place prior to your transmitting the information. For that reason, we ask that you do not send confidential information such as Social Security, credit card, or account numbers to us through an unsecured email.
How Do We Protect Your Information? Information Security -- We utilize encryption/security software to safeguard the confidentiality of personal information we collect from unauthorized access or disclosure and accidental loss, alteration or destruction. Evaluation of Information Protection Practices -- Periodically, our operations and business practices are reviewed for compliance with organization policies and procedures governing the security, confidentiality and quality of our information. Employee Access, Training and Expectations -- Our organization values, ethical standards, policies and practices are committed to the protection of user information. In general, our business practices limit employee access to confidential information, and limit the use and disclosure of such information to authorized persons, processes and transactions.
How Can You Access and Correct Your Information? You may request access to all your personally identifiable information that we collect online and maintain in our database by emailing us using the contact form provided to you within the site structure of our website.
Do We Disclose Information to Outside Parties? We may provide aggregate information about our customers, sales, website traffic patterns and related website information to our affiliates or reputable third parties, but this information will not include personally identifying data, except as otherwise provided in this privacy policy.
What About Legally Compelled Disclosure of Information? We may disclose information when legally compelled to do so, in other words, when we, in good faith, believe that the law requires it or for the protection of our legal rights.
Permission to Use of Materials The right to download and store or output the materials in our website is granted for the user's personal use only, and materials may not be reproduced in any edited form. Any other reproduction, transmission, performance, display or editing of these materials by any means mechanical or electronic without our express written permission is strictly prohibited. Users wishing to obtain permission to reprint or reproduce any materials appearing on this site may contact us directly.

Terms & Conditions

Terms & Conditions

Donation Refund Policy

We are grateful for your donation and support of our organization. If you have made an error in making your donation or change your mind about contributing to our organization please contact us. Refunds are returned using the original method of payment. If you made your donation by credit card, your refund will be credited to that same credit card.

Automated Recurring Donation Cancellation

Ongoing support is important to enabling projects to continue their work, so we encourage donors to continue to contribute to projects over time. But if you must cancel your recurring donation, please notify us.

Who We Are
Our Services
Donations and Sponsorships
Careers and Volunteers

Donate Today
Volunteer
Upcoming Events
Get Our Newsletter
For Services 512-451-2242

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