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 to provide input and guidance to the Board related to: advocacy, diversity/equity/inclusion, finance, governance, quality improvement, risk management and strategic planning.

Name(Required)

First Last

Address(Required)

Street Address City 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 (current or past)

Staff Member

Volunteer

News Ad

Social Media

Website

Other

Please indicate 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)

Is this time frame suitable/feasible for you?

Yes

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)

Please indicate your preference.

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 conduct much of the work of the Board and consist of Board members, community members and staff resource members. Each Board member is asked to serve on at least one (1) committee. Please rank your areas of interest/strength with the number one choice being your highest priority.

First Choice(Required)

Second Choice(Required)

Third Choice(Required)

Fourth Choice(Required)

Fifth Choice(Required)

Sixth Choice(Required)

Last Choice(Required)

Are you available to attend meetings during standard business hours (Monday - Friday) between the hours of 8:00 am - 5:00 PM(Required)

Yes

Sometimes

Comment(s):

Are you able to attend meetings on weekday evenings (Monday - Friday) between the hours of 5:00 - 8:00 PM(Required)

Yes

Sometimes

Comment(s):

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(Required)

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

ConnectWell Application for Prospective Board and Committee Members

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