Board Member Application

Summit Outreach and Counselling Inc. Board Member Application Form. Complete the form below to apply to join the board.

Board service expectations: board members are expected to attend board meetings regularly, declare any conflict of interest in relation to Summit Outreach and Counselling Inc., complete a conflict of interest form if appointed, and provide a recent Criminal Record Check (and Vulnerable Sector Check if applicable) as a condition of serving.

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Name *

First

Last

Phone Number

Email *

Address

Occupation

Position(s) interested in

• General board member
• Chair
• Treasurer
• Secretary

Why are you interested in joining the board of Summit Outreach and Counselling Inc.?

Previous board or committee experience (please describe)

What skills or qualities do you bring to the board?

Any certifications or training relevant to board service

Are you able to attend board meetings regularly?

• Yes
• No

Do you have any conflict of interest to declare in relation to Summit Outreach and Counselling Inc.? If so, please describe.

Conflict of Interest Agreement

• I agree to complete a conflict of interest form if appointed.

Reference 1 Name *

First

Last

Reference 1 Relationship

Reference 1 Phone Number

Reference 1 Email *

Reference 2 Name *

First

Last

Reference 2 Relationship

Reference 2 Phone Number

Reference 2 Email *

Summit and Agreement

Criminal Record Check

• I agree to provide a recent Criminal Record Check (and Vulnerable Sector Check if applicable) as a condition of serving.

Acknowledgment and Signature

• I acknowledge the board service expectations and agree to uphold them.

Signature (typed full name)

Date

Submit