Board of Directors Application Form

To be completed by the nominee, confidential when completed.

"*" indicates required fields

Name*
Date of Birth*
Address*

Please list your current organizational affiliations (names of the organization and your role(s)):
Organization
Role
 
What would you like to get for yourself out of your participation on the Board? (e.g. what types of experiences, skills to develop, interests to cultivate etc.?)
Which of your skills would you like to utilize on the Board?*

If you are appointed to the Board of Directors, you agree that you can commit to at least 2-4 hours per month to attend Board and/or committee meetings, and that you do not have any conflict of interest in sitting on the Board.

MM slash DD slash YYYY

If you would like the printable version of the application form, please click here.