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ConnectWell Application for Prospective Board and Committee Members
Thank you for expressing an interest in serving on the Board and/or the Committees of ConnectWell Community Health. ConnectWell Community Health is a charitable organization that oversees many different services that support the health and well-being of our community. Our 13-member Board of Directors ensures good governance and uses a consensus decision-making model. Committees of the Board provide a mechanism for community members and staff to provide input and guidance to the Board related to: Finance, Governance, Joint Planning (with local government), Nominating, and Planning & Review functions.
Name
(Required)
First
Last
Address
(Required)
Street Address
City
ON
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Email
(Required)
Phone
(Required)
How did you hear about current openings we have for Board and/or Committee Members
(Required)
(check all that apply)
Board Member
Staff Member
Volunteer
News Ad
Social Media
Website
Other
If none of the above options aren't applicable, please indidcate here how you heard about our current openings for Board and/or Committee Members
(Required)
The standard term of office for our Board Members is three years.
(Required)
Yes
No
Unsure
Our by-laws enable members to serve a lesser term under certain circumstances or to return for an additional three-year term.
(Required)
Please comment if an initial three year term of service is not feasible for you to make.
In order to facilitate the development of a balanced Board, the Nominating Committee may ask some Board candidates if they would be willing and interested in serving on a Committee for a year before serving on the Board.
(Required)
I am primarily interested in serving on the Board of Directors, which includes Committee work
I am primarily interested in serving on a Committee as a Community member
I would serve on either a Committee or the Board of Directors
Committees consist of Board members, community members and staff resource members. Committees conduct much of the work of the Board.
Each Board member is asked to serve on at least one (1) committee. Please rank (from 1 - 5) the following committees in your order of preference with the #1 choice being your highest priority and the #5 choice being your lowest priority.
The
Finance Committee
ensures the organization’s financial affairs meet generally accepted professional standards for financial planning, management and reporting.
Approximately 5 meetings/year.
The Finance Committee would be my:
(Required)
Use the down arrow at the end of the box to change your choice.
First Choice
Second Choice
Third Choice
Fourth Choice
Fifth Choice
Not a Choice
The
Governance Committee
ensures the Board’s decision-making, structure, policies and procedures, etc.) are working effectively. Evaluates the work of the Board.
Approximately 8 meetings/year.
The Governance Committee would be my:
(Required)
Use the down arrow at the end of the box to change your choice.
First Choice
Second Choice
Third Choice
Fourth Choice
Fifth Choice
Not a Choice
The
Joint Planning with the Township of Lanark Highlands
provides a liaison function with local government (Township of Lanark Highlands).
1-3 meetings /year.
The Joint Planning with the Township of Lanark Highlands Committee would be my:
(Required)
Use the down arrow at the end of the box to change your choice.
First Choice
Second Choice
Third Choice
Fourth Choice
Fifth Choice
Not a Choice
The
Townships of Whitewater Region and Bonnechere Valley Healthier Community Committee
initiates and co-ordinates activities and advocacy towards the achievement of common goals of ConnectWell (Renfrew County sites) and community partners.
Approximately 8 meetings/year.
The Townships of Whitewater Region and Bonnechere Valley Healthier Community Committee would be my:
(Required)
Use the down arrow at the end of the box to change your choice.
First Choice
Second Choice
Third Choice
Fourth Choice
Fifth Choice
Not a Choice
The
Nominating Committee
oversees succession planning, the recruitment of new members to serve on the Board of Directors and community members to serve on Board Committees.
Approximately 6 meetings/year.
The Nominating Committee would be my:
(Required)
Use the down arrow at the end of the box to change your choice.
First Choice
Second Choice
Third Choice
Fourth Choice
Fifth Choice
Not a Choice
The
Planning & Review Committee
ensures the organization conducts and follows strategic planning activities and oversees quality improvement processes.
Approximately 8 meetings/year.
The Planning & Review Committee would be my:
(Required)
Use the down arrow at the end of the box to change your choice.
First Choice
Second Choice
Third Choice
Fourth Choice
Fifth Choice
Not A choice
Are you able to attend meetings during working hours (Monday - Friday) between the hours of 8:00 am - 5:00 PM
(Required)
Yes
No
Sometimes
Are you able to attend meetings on weekday evenings (Monday - Friday) between the hours of 5:00 - 8:00 PM
(Required)
Yes
No
Sometimes
What interests you about serving on the Board and/or Committee(s) of ConnectWell Community Health?
(Required)
Please outline your skills, education, employment, and/or life experience that will inform your work in this volunteer position.
(Required)
Please identify or describe any unique skills, interests or perspectives that you think might be of service to ConnectWell Community Health.
(Required)
Please describe how you have been involved in your community (previously or currently).
(Required)
What would you like to get out of your experience on the Board and/or Committee(s)?
(Required)
Do you have any other comments or information that you would like to share?
Please provide the contact information (name, address, phone number and/or email address) for two professional or community members who could be contacted to provide a reference for you.
I agree to have the references listed below contacted by ConnectWell Community Health.
(Required)
Yes
First Reference Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Second Reference Name
First
Last
Email
(Required)
Phone
(Required)
The information you provide on this form will help the Nominating Committee ensure an appropriate “match” between your interests, skills and availability, and the current needs of the Board of ConnectWell Community Health.
When recruiting candidates for the Board, the Nominating Committee takes into account several factors including knowledge of our catchment area, relevant work and volunteer experience, knowledge of the field of services of ConnectWell Community Health, skills and current needs/gaps on the Board.
We strive to ensure that the diversity in our community is represented.
Please note: All Board members will be asked to sign a Statement of Confidentiality, Code of Conduct, and provide a satisfactory and current Criminal Records Check.
Thank you for your interest in serving on the Board of ConnectWell Community Health -
together we are building a stronger, healthier community
Find Out What Services Are Available To You
Select Location
Carleton Place
North Lanark
Leeds and Grenville
Renfrew County
