NOVUS Health Board Member Application
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Briefly describe why you would like to join our Board of Directors.
Your current organizational affiliations:
Rows
Name of Organization
Your Role
Which of your skills would you like to utilize on the Board? Check those that apply:
Board development
Financial management
Training
Strategic planning
Fundraising
Marketing
Staffing / HR
Evaluation
Volunteer management
Program development
Community networking
Facilities management
Other skill(s) of yours that you would like to utilize?
Please upload a copy of your resume.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Which Board Committee would you like to participate in? Check those that apply:
Executive
Finance
Clinical Excellence
Ad Hoc
Currently we are meeting on the fourth Wednesday of the month at 6pm. Does this timing work with your schedule?
Yes
Sometimes
No
If you join the Board, you agree that you can provide at least 2-4 hours a month in attendance to Board and Committee meetings, and that you do not have any conflict-of-interest in participating on the Board.
If you are not selected as a member of the Board, or if you decide not to join, would you like to be a volunteer to assist our organization in various ways that match your skills and interests?
Yes
Maybe
No
Submit
Should be Empty: