Form
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Heading
Eligibility Criteria & Required Information
Are you able to attend meetings on Zoom?
Yes
No
Do you live in the Hamilton-Niagara-Haldimand-Brant area?
Yes
No
Are you over the age of 18?
Yes
No
Do you agree to maintain Board confidentiality?
Yes
No
Have you ever been declared incompetent to manage your own affairs by a judge?
Yes
No
Are you currently in undischarged bankruptcy?
Yes
No
Do you have the time and capacity to carry out the duties and responsibilities of a Director of the Board?
Yes
No
Do you have lived or living experience with mental illness and/or addictions?
Yes
No
Have you been employed by the Consumer/Survivor Initiative of Niagara in the last two (2) years?
Yes
No
Do you agree to sign agreements of ethical conduct and confidentiality?
Yes
No
Are you a member of CSIN's peer support groups?
Yes
No
Why do you want to become a member of the CSIN Board of Directors?
What unique skills and experience would you bring to the Board?
Do you have any previous experience with being on a Board?
Do you have any other relevant volunteer experience?
Is there anything else you would like us to know about you as a potential Board member?
Date
-
Month
-
Day
Year
Date
Signature
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