2019 Missouri Health Care for All Board & Leadership Application

Thank you for your interest in leadership of Missouri Health Care for All. Please click Submit to send this application. A member of our Board or Staff will be in touch soon about the status of your application.

Our Board of Directors is looking for new members to help advance our vision of quality, affordable health care for all Missourians. To help us elect the best possible slate for the organization, interested potential board members are asked to complete this application. We will review all of the received applications and nominate a slate that brings the greatest strength possible to the board.

If you are not nominated for a board position at this time, we will contact you about other ways you can help Missouri Health Care for All.

Before applying, please be sure you have read about the responsibilities of MHCFA Board members at https://mohealthcareforall.org/seeking-board-members/.

APPLICATION DEADLINE FOR THE 2019 ELECTION HAS BEEN EXTENDED TO FRIDAY, APRIL 26th AT 5:00 PM CENTRAL TIME.

Thank you for your interest!

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* 1. Name and Contact Information:

Name:

Address:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

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* 2. Please select one:

I am interested in joining the Missouri Health Care for All Board of Directors representing my congregation, organization or faith tradition.

I am interested in joining the Board as a community volunteer.

Please specify organization, if applicable:

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* 3. Please describe your interest in being part of Missouri Health Care for All's leadership. Why, of all the places where you could volunteer your time, do you want to serve on this Board?

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* 4. Have you previously been involved with Missouri Health Care for All? If so, how?

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* 5. 3. Please share a brief biography. What do (or did) you do for work? Are you currently working, in school, retired, etc? Do you have personal connections to this organization or our mission? What else can you share that would help our current board members get to know you? (Please feel free to upload your bio using the next question if that is easier.)

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* 6. Alternatively, please upload a narrative biography (not a resume or CV, please).

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 7. Please tell us about other organizations where you have volunteered or served as a board member (current or past).

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* 8. Please check all constituencies to which you belong or are connected:

Low-income Missourians

Rural communities

Urban communities

African-Americans

Hispanics/Latinos

Immigrants

People with disabilities

People with mental illness

Children

Union/labor movements

People who are uninsured or underinsured

Health care providers

Faith leaders

Populations with a particular type of illness

Other (please specify)

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* 9. What particular skills, interests, or experience can you contribute to Missouri Health Care for All?

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* 10. With which of the following aspects of our work would you be most interested in assisting?

Mobilizing individuals and organizations (grassroots organizing)

Organizational governance

Financial management

Policy analysis

Public education

Fundraising and development

Other (please specify)

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* 11. (Disclosure of potential conflicts of interest)

Are you directly or indirectly affiliated with a health provider or health insurance company?

Please disclose if you work, lobby or serve as a board member of a health care company, insurance company, hospital, or other medical provider.

Yes (Please describe)

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* 12. If you are not selected for board leadership, are you interested in working with Missouri Health Care for All in other ways?

Yes

Unsure

Comments:

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* 13. I submit this application for the Board of Directors of Missouri Health Care for All. I attest I have reviewed the responsibilities of MHCFA Board members and am willing to fulfill these responsibilities, including making a time commitment of approximately 5-10 hours per month. I have answered the questions above completely and truthfully.

Name:

Date:

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* 1. Name and Contact Information:

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* 2. Please select one:

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* 3. Please describe your interest in being part of Missouri Health Care for All's leadership. Why, of all the places where you could volunteer your time, do you want to serve on this Board?

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* 4. Have you previously been involved with Missouri Health Care for All? If so, how?

Question Title

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* 6. Alternatively, please upload a narrative biography (not a resume or CV, please).

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* 7. Please tell us about other organizations where you have volunteered or served as a board member (current or past).

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* 8. Please check all constituencies to which you belong or are connected:

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* 9. What particular skills, interests, or experience can you contribute to Missouri Health Care for All?

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* 10. With which of the following aspects of our work would you be most interested in assisting?

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* 11. (Disclosure of potential conflicts of interest)Are you directly or indirectly affiliated with a health provider or health insurance company? Please disclose if you work, lobby or serve as a board member of a health care company, insurance company, hospital, or other medical provider.

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* 12. If you are not selected for board leadership, are you interested in working with Missouri Health Care for All in other ways?

Question Title

* 11. (Disclosure of potential conflicts of interest)

Are you directly or indirectly affiliated with a health provider or health insurance company?

Please disclose if you work, lobby or serve as a board member of a health care company, insurance company, hospital, or other medical provider.