Director Application

Name *

Email *

Phone *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Employer/Occupation *

Educational Background

Community Activities (boards, committees, etc.)

Briefly describe what you believe qualifies you to be a Polar Board member

Do you have any specific goals for Polar Communications?

Are you related to any board member or employee at Polar Communications?

Provide any additional relevant information:

Are you a natural person? *YesNo

Are you a member in good standing (a member in good standing is a member who takes wireline telephone or broadband Internet service from Polar and pays all amounts owed to Polar as and when such amounts are due and payable)? *YesNo

Are you presently residing and have resided for the past two (2) consecutive years and shall remain a resident of the area served or to be served by the Cooperative? *YesNo

Are you in any way employed or financially interested in a competing enterprise or business engaged in selling communications service or supplies or constructing or maintaining facilities? *YesNo

Are you a current employee or the spouse of any employee? *YesNo

Are you a former employee who has been employed by the Cooperative on a full-time basis during the past five 5) years, or the spouse of a former employee or spouse thereof, who is covered by any retirement or insurance benefit paid for partly or completely by the Cooperative? *YesNo

Are you a convicted felon of any State or Federal crime? *YesNo

Have you filed for bankruptcy at any time? *YesNo

Are you able to attend a minimum of ten (10) regular scheduled board meetings, beginning with the board meeting in the month elected? *YesNo

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I certify that I have read, understand, and fully comply with the qualifications to be nominated as a director.

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