Application to the Board of Directors Question Title * 1. Name Question Title * 2. Phone number Question Title * 3. Email address Question Title * 4. Address Question Title * 5. Occupation Question Title * 6. Your background Question Title * 7. What skills would you contribute to our Board? Business Children's services Cultural diversity Fundraising Governance Health care Human Resources Legal Lived experience - family advocate Lived experience - self-advocate Property management Public relations/media Seniors' services Social work Other (please specify) Question Title * 8. What other Boards have you served on? Question Title * 9. Are you willing to commit to a three-year term? Yes No Question Title * 10. Can you regularly attend Board meetings? Yes No Question Title * 11. Can you commit to one Board and one Committee meeting per month and complete preparation work? Yes No Question Title * 12. Are you available for day and evening meetings? Yes No Question Title * 13. What is your interest in Community Living Parry Sound? Question Title * 14. Reference #1 Name Phone number Email Question Title * 15. Reference #2 Name Phone number Email Question Title * 16. Reference #3 Name Phone number Email A criminal reference check is required and will be coordinated by Community Living Parry Sound. Question Title * 17. Signature (please type your name if completing online) Done