HMIS Board Co-Chair Application

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* 1. Name

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* 2. Organization/Agency:

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* 3. Phone

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* 4. Email

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* 5. What is your race?

African American/Black

Asian

Caucasian/White

Hispanic/Latina/Latino

Native American

Multiple Races

Prefer Not to Answer

Prefer to Self-Describe (enter answer below)

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* 6. What is your geographic location? (check all that apply if serving more than one)

Metro

Suburban Metro

Northeast

Northwest

Central

Southeast

Southwest

West Central

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* 7. Do you have lived experience of homelessness?

Yes

No

Prefer Not to Answer

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* 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.

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* 9. What HMIS committees/workgroups have you served on? (please list)

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* 10. Describe what professional skills and experience you would bring to the board?

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* 11. In one or two sentences, describe why you are interested in this position?

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* 12. Is there any additional information that you would like the board to know?

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* 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.

Yes

No