LeadUS Mentoring Program 2015-16

Board of Directors Canidate Applicant Form

Thank you for your interest in serving as a Director for the Board of Directors of the Central Coast Childbirth Network. Serving on the board is a rewarding experience and an opportunity for personal and professional growth. Reviewing this form will assist you in understanding the skills and time/resource commitments of this leadership position. You may find it helpful to read through the entire application and Board Member Responsibilities before you begin filling it out. This application will be kept confidential and on file with the Secretary. Applications are used by the Board of Directors to identify and evaluate potential board candidates. All new Directors are elected by a majority vote of current board and are expected to attend all Board Meetings. Committees, Fundraisers and main Program offerings are optional but participation is encouraged.
Please review the Board Meeting Schedule, Directors & Officers Roles and Responsibilities and the CCCN Vision, Values and Mission.

Expect 4 Board Meetings per year and 1 Board retreat weekend.

Questions? Contact zabrina@centralcoastcn.org or Susannah@centralcoastcn.org.
2022 CCCN Board Meeting and Committee Schedule
CCCN Mission, Vision, Values & Board Expectations
Today's Date*

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Date
Applicant Name*

Last NameFirst Name
Applicant Address*

Street Address

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CityState / Province

Postal / Zip Code
Applicant Phone Number*
Applicant Email*
Applicant Birth Date*

MonthDayYear
My current principal employment is as follows (Name of Employer & Address/Position or Duties):*
Please share with us why you are interested in joining our organziation:*
Have you served on other nonprofit organization boards? If so, please list them and any offices you held: *
What personal or professional skills and strengths would you bring to the CCCN? Include any experiences, expertise, connections and resources.*
What current associations, club affiliations, and/or volunteer commitments do you currently have?*
2022 Organizational Structure 2022
Please check any of the following ways you are willing to support CCCN:*

Vice PresidentSecretaryBoard MemberCommittees: Governance, InternalCCCN to Professionals ProgramCCCN Professionals to Community ProgramProgram Director of CCCN to ProfessionalsProgram Director of Professionals to Community ProgramFundraising
After Reviewing the CCCN “Conflict of Interest Policy” Please Explain if you are aware of any situation that might be perceived by others as a “Conflict of Interest” if you are appointed:*
Attatch Resume (optional)

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Attatch additional documents, letters, statements (optional)

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After your application has been reviewed you may be asked to interview in order for us to better get to know you. Thank you for your interest.
I certify, by my signature, that the information contained within this application and all supporting documents (i.e., resume, recommendation letters, etc.) is true, accurate, and complete to the best of my knowledge. An electronic signature is accepted.

Central Coast Childbirth Network, INC ensure the right of all association members to appropriate and effective services without discrimination on the basis of the organization’s volunteer or staff make-up in respect to gender, sexual orientation, national origin, race, religion, age, political affiliation or disability, in accordance with all applicable legal and regulatory requirements.
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Board of Directors Canidate Applicant Form