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HMIS Board Co-Chair Application
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1.
Name
(Required.)
2.
Organization/Agency:
*
3.
Phone
(Required.)
*
4.
Email
(Required.)
*
5.
What is your race?
(Required.)
African American/Black
Asian
Caucasian/White
Hispanic/Latina/Latino
Native American
Multiple Races
Prefer Not to Answer
Prefer to Self-Describe (enter answer below)
*
6.
What is your geographic location? (check all that apply if serving more than one)
(Required.)
Metro
Suburban Metro
Northeast
Northwest
Central
Southeast
Southwest
West Central
*
7.
Do you have lived experience of homelessness?
(Required.)
Yes
No
Prefer Not to Answer
*
8.
Please describe your experience and length of time using HMIS? (data entry, run reports, etc.) If you have not used HMIS, please enter N/A.
(Required.)
9.
What HMIS committees/workgroups have you served on? (please list)
10.
Describe what professional skills and experience you would bring to the board?
11.
In one or two sentences, describe why you are interested in this position?
12.
Is there any additional information that you would like the board to know?
*
13.
As you consider this opportunity, please familiarize yourself with the following list of expectations for board members and indicate whether you are willing to meet these expectations.
a. I will regularly attend board meetings.
b. I will actively participate in one or more standing committees.
c. I will stay informed on HMIS board issues, policies, and other board
matters by reading the Governance packet information, and board packet
materials.
d. I will participate in discussions and decisions on issues, policies, and other board matters.
e. I will disclose any conflicts of interest and excuse myself from votes in
which I have a conflict of interest
f. I will work in good faith with HMIS staff and other board members as
partners towards achievement of our goals.
(Required.)
Yes
No
Current Progress,
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