Board Membership Application

The Kentucky Council on Problem Gambling is a statewide nonprofit organization working to increase awareness of problem gambling, strengthen prevention and research, and advocate for the availability of treatment. KYCPG is neutral on legalized gambling. The Council seeks an active, representative Board whose members bring professional knowledge, community connections, and lived or family perspectives from across Kentucky.

Board Service at a Glance

Governance and stewardship: help guide mission, strategy, finances, policies, partnerships, and organizational sustainability.
Active participation: prepare for meetings, contribute to decisions, and accept committee, project, or outreach responsibilities.
Statewide representation: help KYCPG understand and engage Kentucky’s varied regions, communities, sectors, and people affected by gambling-related harm.
Independent judgment: act in KYCPG’s best interests rather than as a delegate of an employer, funder, industry, or constituency.
Selection: submission begins a review process and does not guarantee nomination or election. Strong applicants may also be considered for future, advisory, or committee service.

Board Membership Application

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Applicant Information

Full Name(Required)

First Middle Last

Preferred Name

First

Credentials

Email(Required)

Phone(Required)

Preferred Method for Follow-Up

Phone

Best Times to Contact

Please enter your availability.

Address(Required)

Street Address City State ZIP Code

Kentucky County(Required)

Professional Information

Current Role or Job Title(Required)

Employer/Organization(Required)

Professional Website or LinkedIn

Primary Sector

Kentucky Regions or Communities Served(Required)

Interest and Mission Alignment

Why are you interested in serving on the KYCPG Board, and what part of the mission most connects with you?(Required)

KYCPG is neutral on whether gambling should be legal and focuses on awareness, prevention, research, treatment access, and recovery. How would you uphold that neutrality while contributing your perspective?(Required)

What two or three outcomes should KYCPG prioritize over the next two years, and how would you help advance them?(Required)

Leadership and Governance Experience

List current or previous boards, advisory groups, coalitions, committees, or community leadership roles. Include your role and approximate dates.(Required)

Describe a time you worked with people or organizations holding different viewpoints to reach a shared goal. What did you contribute?(Required)

Skills and Perspectives

Professional and Governance Skills(Required)

Check the areas in which you can make a meaningful contribution now. Formal credentials are not required for every area.

Nonprofit governance and board development

Strategic planning and organizational growth

Finance, accounting, audit, or investment

Legal, ethics, compliance, or risk

Human resources and workforce development

Fundraising, sponsorships, or grant development

Public policy, government relations, or advocacy

Research, data, evaluation, or quality improvement

Communications, media, marketing, or public education

Conference, event, or training development

Technology, cybersecurity, or digital engagement

Other professional or governance expertise

Briefly Explain Other Expertise(Required)

Program and Community Perspectives(Required)

Check the areas in which you can make a meaningful contribution now. Formal credentials are not required for every area.

Problem gambling treatment or clinical services

Prevention, public health, or harm reduction

Peer support, recovery, family, or affected-other perspective

Responsible gambling or gaming operations

Regulation, lottery, racing, sports betting, or charitable gaming

Financial services, debt, or consumer protection

Youth, education, or collegiate well-being

Military or veteran communities

Rural, underserved, or access-focused work

Faith, civic, business, or community partnerships

Accessibility, cultural responsiveness, or language access

Other program, community, or lived perspective

Briefly Explain Other Expertise(Required)

What Kentucky communities, regions, sectors, or networks can you help KYCPG understand or engage?(Required)

No director is expected to speak for an entire community.

Relevant lived, family, or community experience

If you wish, describe personal, family, professional, or community experience that informs your perspective on gambling-related harm, prevention, treatment, recovery, responsible gambling, or affected families. Share only what you are comfortable disclosing. Do not include diagnoses, protected health information, or identifying details about another person.

Availability and Service Commitments

KYCPG plans approximately five Board meetings each year, often on Fridays in rotating Kentucky locations. Virtual attendance can be accommodated, but Board members must attend at least three meetings in person annually to retain Board membership. Directors review materials in advance and may also support committee, conference, awareness, or resource-development activities. Dates, locations, and formats may change with sufficient notice when possible.

I can prepare for and attend approximately five Board meetings per year.(Required)

Yes

I would like to discuss

I can participate on at least one committee, work group, or time-limited project.(Required)

Yes

I would like to discuss

I can attend at least three Board meetings in person each year to retain Board membership.(Required)

Yes

I would like to discuss

I can support selected conference, awareness, education, or outreach activities.(Required)

Yes

I would like to discuss

I can support resource development in ways appropriate to my skills and circumstances, such as introductions, stewardship, events, storytelling, sponsorship outreach, donor visits, or solicitation.(Required)

Yes

I would like to discuss

Known scheduling, travel, employer, or other limitations you would like the Board to consider.

If selected, I understand that directors are expected to:

Act in good faith, on an informed basis, and in the best interests of KYCPG.
Support KYCPG’s gambling-neutral mission and help ensure that no single stakeholder dominates Board decisions.
Prepare for and participate in meetings, ask questions, and accept shared responsibility for Board decisions.
Disclose actual, potential, perceived, or apparent conflicts and recuse myself when required.
Protect confidential information and communicate respectfully using recovery-oriented, stigma-free language.
Follow the bylaws, Board-approved policies, code of conduct, and authorized spokesperson procedures.
Complete orientation and any required annual disclosures or governance education.

Board Responsibility Acknowledgment(Required)

I can meet these expectations

I would like to discuss one or more expectations.

Conflicts and Independence

Disclosure is not automatically disqualifying. It allows KYCPG to determine whether an actual, potential, perceived, or apparent conflict can be avoided or managed. Include relevant financial, employment, governance, family or close personal, donor or funder, industry, vendor, treatment-provider, research, regulatory, government, grant, lobbying, or contractual relationships.

Do you know of any relationship or interest that could create a conflict with your Board service?(Required)

Yes

Unsure

Describe the relationship and how it might be managed.

Could any current role, policy, contract, public position, or other obligation limit your ability to advocate, support resource development, vote independently, or act in KYCPG's best interests? If so, please explain.

If selected, I agree to disclose conflicts annually and when circumstances change, and to abstain or recuse when required.(Required)

Yes

I would like to discuss

Attachments and Future Consideration

Résumé Attachment

Optionally, you may attach your résumé. PDF files only.

Accepted file types: pdf, Max. file size: 50 MB.

Optionally, provide a brief biography, or your LinkedIn/professional profile.

If requested, I am willing to provide two references who can speak to my judgment, reliability, collaboration, and community relationships.(Required)

Yes

I would like to discuss

If there is no current Board vacancy, KYCPG may retain my application and consider me for a future Board vacancy.(Required)

Yes

I would like to discuss

Applicant Certification

Certification(Required)

I certify that the information in this application is accurate to the best of my knowledge. I understand that submission requests consideration but does not guarantee nomination or election. If nominated and elected, I am willing to serve and to review, sign, and comply with KYCPG’s bylaws, Board Member Agreement, conflict-of-interest policy, confidentiality policy, code of conduct, and other applicable requirements. Any public use of my biography, photograph, or personal story will require separate consent.

I agree.