New Chapter Formation Petition Form

I desire to begin the process of Chapter Formation of a new MAsT Chapter in conformity with the MAsT Policy Manual, following the process of the MAsT Chapter Formation Manual, and in full cooperation with Masters And slaves Together, International. I understand that Chapter Directors must be at least 18 years of age, but not younger than the legal age of adulthood in my local governmental jurisdiction.
Your chapter name must begin with "MAsT:" followed by the city or town where meetings will be held. (not the county or geographic region, as per page 2 of the New Chapter Formation Manual).
Proposed Chapter Name 1:
Proposed Chapter Name 2:
Proposed Geographical Service Area:
City:
State/Province (SPELL OUT e.g. "California" NOT "CA", except for District of Columbia):
M/s population served (Pansexual, Women Only, Men Only, GLBT, etc.):
Director:		Co-Director:
Legal Name:		Legal Name:
Preferred Name:		Preferred Name:
Email Address:		Email Address:
Address (1):		Address (1):
Address (2):		Address (2):
City:		City:
State/Province (SPELL OUT e.g. "California" NOT "CA", except for District of Columbia):		State/Province (SPELL OUT e.g. "California" NOT "CA", except for District of Columbia):
Postal Code:		Postal Code:
Country:		Country:
Phone (Including Area Code):		Phone (Including Area Code):
Best time(s) to call:		Best time(s) to call:
Cell Phone (Including Area Code):		Cell Phone (Including Area Code):
Best time(s) to call:		Best time(s) to call:
Fax Number (Including Area Code):		Fax Number (Including Area Code):
Reference 1 (for Director):		Reference 1 (for Co-Director):
Name:		Name:
Email:		Email:
Reference 2 (for Director):		Reference 2 (for Co-Director):
Name:		Name:
Email:		Email:
Personal Qualities This electronic questionnaire provides you with the opportunity to explain some of your personal qualities and what knowledge and skills you can offer for the job. In addition to your basic resume information, the selection will be based on your responses on the questionnaire and any potential interview. The Personal Qualities desired are: being respected by the M/s community, reliable, and trustworthy, respects policies and procedures, forthright, authentic and, willing to contribute as a team member.
Personal Qualities (for Director):		Personal Qualities (for Co-Director):
Personal Competencies Competencies are all of the knowledge, skills, and other attributes (e.g., willingness) that is required to perform an activity. Competence is the developed skills to accomplish various levels of the activities. A 5-point competence scale from 1 (low) to 5 (High) can include: Level 1, learning basic knowledge and skills that allow safe, reliable work with direct oversight; Level 2. Understands all knowledge and can complete all basic skills with less direct oversight and is learning more complex knowledge and skills; Level 3. Understands all knowledge and skills for accomplishing complex requirements of the job with minimal oversight; Level 4. Continually exhibits highly developed skills and provides insight for new knowledge or highly complex procedures and is included in expert discussions; Level 5. Provides expert advice and understanding, develops new complex thoughts and activities, recognized by others as the "go to" person for designing, developing, and implementing new processes or procedures. The Competencies considered important include: experience coaching and influencing others, communicating effectively, resolving conflicts, networking, leading by example, thinking politically (the need to give and take for the sake of organizational success), being approachable and, evidence of consistent positive outcomes over an extended period. Explain your experiences for each of the competencies and add your estimated competence (Level 1-5) for each competency.
Personal Competencies (for Director):		Personal Competencies (for Co-Director):
Enter the number shown above
Sign this document by entering your email address: