Board & Committee Application

General Information – please review

Attachments

There is a check box at the end of the application indicating that you have read and agree to the following:

Your Name (required)

Address (required)

Contact Phone (required)

Your Email (required)

I would like to be considered for (required)

Please specify if you selected 'Community Member on Board Standing Committee'

A. Briefly highlight experience as it pertains to the Board’s or Committee’s Mandate for which you are applying. (80 words or less) (required)

B. If you have previously served on a Board or Management Committee for a Non-profit entity please describe responsibilities & accomplishments briefly. (required)

C. List other volunteer activities & your role. (required)

D. Rate your skills/experience from 0 to 3 (0=no experience; 1=low - basic-understanding; 2=intermediate; 3=advanced) for each of the following:

Governance

Financial/Accounting

Legal

Information Technology

Clinical (hospital/nursing home)

Human Resources Management

Strategic Planning

Stakeholder Engagement (including patient voice)

Systems Thinking (integration/collaboration)

Risk Management

Quality & Performance Management

Change Management

Communications and Marketing

Population Health

Government Relations

Service Integration/Collaboration

Health Administration

Health Service Policy Development

Business Management

Construction and Project Management

Ethics

Advocacy

E. Briefly, explain your interests in &/or concerns about our health care system today. (required)

F. Is there any other information you would like us to be aware of with respect to your application including any skills that you believe can make a contribution to the Board’s and Committees work. (required)

G. Please provide the names of two references (and their contact phone #) who would be willing to verify your application information. (required)

I acknowledge that I have read and understood the terms and conditions of attachments 1, 2, and 3 above. (required)

2+3 (required)