LeadUS Mentoring Program 2015-16

Ongwanada Developmental Services

Board of Directors Member Application Form
Personal Information
Name*

First NameLast Name
Date*

YearMonthDay
Date
Email*
Address*

Street Address

Street Address Line 2

CityProvince

Postal / Zip Code
Phone Number*
Home Phone
Birth Date*

YearMonthDay
Gender

FMOther
Business/Work Information
Title/Profession
Company Organization
Type of Business
Employer email
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone
Extension
Please list your past Board & Committee experiences (business, civic, community, fraternal, political, professional, recreational, religious, social). List organization, role/title & years of services
What are your current associations and/or club affiliations (include titles if possible)
Please confirm you are a Canadian citizen or permanent resident and reside within the province of Ontario.*

yes, I confirm I am a Canadian citizen and reside within the province of OntarioNo, my status is: ________________________________
Please check all that apply as areas of your skills and expertise

FinanceBusinessHuman Resources ManagementHealth Care Admin & PolicyClinicalGovernment & Gov RelationsPolitical AcumenConstruction & Project ManagementLegalStrategic PlanningRisk ManagementInformation TechnologyAccountingEducationResearchQuality & Performance ManagementLabour RelationsBoard & GovernancePublic Affairs & CommunicationsEthicsPatient & Health Care AdvocacyExperience with Individuals w/Dev DisabilitiesFrench LanguageFundraisingFundraisingNonprofit ExperienceOther
Attach a copy of your RESUME/CV and/or show your educational background below:

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Include educational background here:
Please describe in details some of your greatest strengths and weaknesses
What do you feel is essential to ensure that the Board and staff are successful in attaining the goals for this organization?
What experiences, expertise, connections, or resources would you bring to Ongwanada?
Please detail your interest in joining this Board
What type of Board tasks do you prefer?
Ongwanada Directors might take on special projects, in addition to their Board responsibilities, to assist Ongwanada in its initiatives. Please let us know if you have any specific project ideas you would like to propose.
Have you ever been engaged in any specific fundraising efforts? If so with whom, how, and what was the amount raised? Are you comfortable playing an active role in assisting Ongwanada with fundraising efforts?
The Ongwanada Developmental Services Board has standing committees: We encourage you to join one of the standing committees along with being on the Board. Please check if you have skills in either area.

Audit & FinanceGovernance & Nominating
Board members are expected to commit to the role for a minimum of a 3-year term. Will you be able to make this commitment to Ongwanada?

yesnounsure at this point
How much time would you have to dedicate to Ongwanada per month?
Ongwanada Developmental Services’ Board is an exciting and engaging Board. Ongwanada is required to meet as a Board a minimum of 6 times per year, with the last meeting typically being the June Annual Meeting with a July /August break. Meetings can occur in person or by virtual means. Board members are expected to be timely and present at meetings. Between work within and outside of meetings, hours of commitment would usually vary between 3-6 hours per month. Board members are also encouraged to participate in fundraising and development activities. Please indicate any concerns below: . . PLEASE ADD ANY ADDITIONAL INFORMATION YOU WOULD LIKE US TO CONSIDER
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Ongwanada Developmental Services

Personal Information

Business/Work Information