Application Form for Board of Directors and Board Committees
Application Form for Board of Directors and Board Committees
Name: ____________________________________________
Address: ____________________________________________
Tel. Numbers: ____________________________________________
Email Address: ____________________________________________
Why are you interested in serving as Board member or Board committee member?
Please rate your knowledge, skills and experience in each category by checking (√) the most appropriate box.
|Knowledge/Skills/Experience In: |Capable In |Interested In |Fair |None |
|Business Management in a Complex Environment | | | | |
|Accounting / Finance | | | | |
|Construction / Architecture | | | | |
|Healthcare / Clinical | | | | |
|Research, Planning or Delivering programs for PHAs | | | | |
|HIV/AIDS Treatment, Research or Policy | | | | |
|Human Resources Management / Labour Relations | | | | |
|Law | | | | |
|Communications & Government/Public Relations | | | | |
|Governance | | | | |
|Client & Healthcare Advocacy | | | | |
|Fundraising | | | | |
|Capital Campaigns | | | | |
|MOHLTC Workings | | | | |
|Quality, Risk & Performance Management | | | | |
|Strategic Planning | | | | |
|Other (please specify) | | | | |
| | | | | |
Please attach a resume which outlines your knowledge, skills and experience in relation to governance at Casey House.
Please submit this application with a resume by Thursday April 10, 2014 to:
Attn: Heather Robinson Casey House 9 Huntley Street Toronto, ON M4Y 2K8
Fax: 416 962-5147 hrobinson@caseyhouse.on.ca
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