Niagara Health Foundation - Board of Directors Application

Board Member Application Form

Please complete the form below. Applicants are reviewed and vetted by the Niagara Health Foundation's Nominating Committee
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Home Number

Area CodePhone Number
Cellular Number

Area CodePhone Number
Work Number

Area CodePhone Number
Place of Employment*
Other Organizations You Currently Volunteer With*
Why Are You Interested in Joining the Foundation Board?*
What Skills / Network Do You Feel You Would Bring to the Board?*
What Current or Past Board Experience Do You Have?*
Signature*

Clear
Signature date*
Should be Empty:

Board Member Application Form