OAND Application for Nomination to the Board
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Applicant Type
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OAND Member (ND)
Non-Member ND
Public Member (Non-ND)
As an ND applicant, I confirm that I am a registered Naturopathic Doctor in Ontario in good standing with the College of Naturopaths of Ontario (CoNO) and with the OAND.
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Yes
No
Not Applicable (Non-ND Applicant)
Please provide clarification (e.g., licensed in another province, registration pending, etc.):
I confirm that I am at least 18 years of age, am not an undischarged bankrupt, and am not incapable of managing property under the Substitute Decisions Act, 1992 or under similar legislation in another jurisdiction.
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Yes
No
I support the objects and mission of the Association. To the best of my knowledge, and based on my review of the attached Board Conflict of Interest Policy, I am not in a real, potential, or perceived conflict of interest that would prevent me from serving as a Director of the Association. I agree to disclose promptly any such conflict that may arise and to comply with the Association’s conflict of interest procedures.
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Yes
No
Please enter your statement of interest in the text field below addressing the following: a) What do you hope to contribute to the ongoing growth and development of the Ontario Association of Naturopathic Doctors, its Board of Directors, and the profession? b) What is your experience or understanding of Board governance and the role of the Board? c) What related skills and/or experience would you bring to the OAND Board of Directors, particularly in the areas of non-profit governance, policy planning/advocacy, financial management, and government relations?
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Please upload a current copy of your CV.
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In the spirit of fostering a diverse and inclusive Board, you are invited (on a voluntary basis) to share any aspects of your identity, lived experience, or professional background that you believe contribute to diversity, equity, and inclusion. This may include, but is not limited to, experiences related to race, ethnicity, gender identity, sexual orientation, disability, geographic location, socioeconomic background, or other perspectives that shape your leadership lens.
Elected or Appointed Positions - Do you, or a member of your immediate family, hold any appointed or elected positions or offices, including political appointments, elected offices, or positions on a board, committee, advisory body, or governing council, that could create a real, potential, or perceived conflict of interest with your duties as a Director?
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Yes
No
Title and organization of offices held - Please provide the titles of the offices/appointments/advisory positions you or any of your family members hold and the names of the organizations.
Financial Compensation - Do you, or a member of your immediate family, receive financial compensation (including for services performed, funded grants, sponsored lectures, consulting arrangements, employment, or as an owner or part-owner of a business) that could create a real, potential, or perceived conflict of interest in relation to your duties as a Director?
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Yes
No
Description and source of financial compensation - Please provide a description and list sources of financial compensation received by you or any of your family members. (type "none" if none)
Existing Relationships - Other than those disclosed above, do you have any relationships, affiliations, or interests that could compromise, or reasonably be perceived to compromise, your independence, objectivity, or ability to exercise sound judgment in fulfilling your duties as a Director?
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Yes
No
Description of Other Conflicts - Please provide a description and identify the sources of any other real, potential, or perceived conflicts, relationships, or interests held by you or any member of your immediate family that have not been disclosed above. (If none, please indicate “None.”)
Declaration (you must check all boxes to be considered for election to the OAND Board)
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I wish to be considered for nomination to the OAND Board of Directors.
I hereby declare that the information that I have provided on this form is complete and accurate to the best of my abilities.
I authorize the OAND to share any/all information contained in this form and any attached files, including my CV, with all members of the OAND for the exclusive purpose of the OAND Board nomination and elections process.
Date
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Day
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Signature
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