Board of Trustees Application Form

Introduction

About Us

Since 1993, the Leduc Community Hospital Foundation has been building relationships with community partners to support and enhance services provided at our local health care facilities.

About the Board of Trustees

The Foundation's Board of Trustees bring a wealth of knowledge and expertise from diverse backgrounds and experiences. The Board is comprised of volunteers from all walks of life from business and management to health, human resources, and marketing. Each member of the Board has a passion for enhanced health care, and seeks to make a difference for all residents who access health care services within our community.

The Board is responsible for the governance of and providing strategic direction to the organization. Committees of the Board also help inform and guide the Foundation in the areas of governance, finance, fund development and marketing. The Board also oversees the Executive Director, who is responsible for day-to-day management of Foundation programs and staff.

Overall, Trustees contribute their knowledge, expertise and skills to ensure year-to-year excellence of and long-term sustainability for the organization. The Board typically meets 10 times per year and Trustees are required to attend in-person and via teleconference, participating actively in Board business.

Seeking New Board Members
We are currently seeking committed individuals, particularly with either legal or accounting experience, to serve a three-year term on the Board. This is a volunteer (non-paid) position. Interested individuals, who are residents of the communities served by the Foundation (greater Leduc region), are invited to complete this application form and submit it to the Board for consideration.

The Board will review all applications and contact qualified candidates for further discussion. Those individuals invited to become a Trustee must submit to a police reference check prior to being appointed to the Board.

Thank you for your interest in the Leduc Community Hospital Foundation.

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* 1. Contact Information

Full Name

Company

Address

City/Town

Province

Postal Code

Email Address

Phone Number

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* 2. Briefly describe your board experience and volunteer work.

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* 3. Why are you seeking a position on the Foundation Board?

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* 4. What areas of the Foundation’s work are of particular interest to you?

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* 5. Briefly outline the contributions you hope to make to the Board.

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* 6. Using the following ratings, indicate your level of experience/expertise for each of the skills/experience categories below:

	4: I am a subject matter expert in this area (i.e. paid for my skills, knowledge and experience)	3: I have significant skills and/or experience in this area	2: I have moderate skills and/or experience	1: I have limited or no skills and/or experience in this area
Board Governance	Board Governance 4: I am a subject matter expert in this area (i.e. paid for my skills, knowledge and experience)	Board Governance 3: I have significant skills and/or experience in this area	Board Governance 2: I have moderate skills and/or experience	Board Governance 1: I have limited or no skills and/or experience in this area
Business/Management	Business/Management 4: I am a subject matter expert in this area (i.e. paid for my skills, knowledge and experience)	Business/Management 3: I have significant skills and/or experience in this area	Business/Management 2: I have moderate skills and/or experience	Business/Management 1: I have limited or no skills and/or experience in this area
Accounting/Financial	Accounting/Financial 4: I am a subject matter expert in this area (i.e. paid for my skills, knowledge and experience)	Accounting/Financial 3: I have significant skills and/or experience in this area	Accounting/Financial 2: I have moderate skills and/or experience	Accounting/Financial 1: I have limited or no skills and/or experience in this area
Human Resources	Human Resources 4: I am a subject matter expert in this area (i.e. paid for my skills, knowledge and experience)	Human Resources 3: I have significant skills and/or experience in this area	Human Resources 2: I have moderate skills and/or experience	Human Resources 1: I have limited or no skills and/or experience in this area
Risk Management	Risk Management 4: I am a subject matter expert in this area (i.e. paid for my skills, knowledge and experience)	Risk Management 3: I have significant skills and/or experience in this area	Risk Management 2: I have moderate skills and/or experience	Risk Management 1: I have limited or no skills and/or experience in this area
Legal	Legal 4: I am a subject matter expert in this area (i.e. paid for my skills, knowledge and experience)	Legal 3: I have significant skills and/or experience in this area	Legal 2: I have moderate skills and/or experience	Legal 1: I have limited or no skills and/or experience in this area
Government/Stakeholder/Community Relations	Government/Stakeholder/Community Relations 4: I am a subject matter expert in this area (i.e. paid for my skills, knowledge and experience)	Government/Stakeholder/Community Relations 3: I have significant skills and/or experience in this area	Government/Stakeholder/Community Relations 2: I have moderate skills and/or experience	Government/Stakeholder/Community Relations 1: I have limited or no skills and/or experience in this area
Fundraising/Fund Development	Fundraising/Fund Development 4: I am a subject matter expert in this area (i.e. paid for my skills, knowledge and experience)	Fundraising/Fund Development 3: I have significant skills and/or experience in this area	Fundraising/Fund Development 2: I have moderate skills and/or experience	Fundraising/Fund Development 1: I have limited or no skills and/or experience in this area
Public Relations/Marketing	Public Relations/Marketing 4: I am a subject matter expert in this area (i.e. paid for my skills, knowledge and experience)	Public Relations/Marketing 3: I have significant skills and/or experience in this area	Public Relations/Marketing 2: I have moderate skills and/or experience	Public Relations/Marketing 1: I have limited or no skills and/or experience in this area
Health Care Sector	Health Care Sector 4: I am a subject matter expert in this area (i.e. paid for my skills, knowledge and experience)	Health Care Sector 3: I have significant skills and/or experience in this area	Health Care Sector 2: I have moderate skills and/or experience	Health Care Sector 1: I have limited or no skills and/or experience in this area
Leadership/Teamwork	Leadership/Teamwork 4: I am a subject matter expert in this area (i.e. paid for my skills, knowledge and experience)	Leadership/Teamwork 3: I have significant skills and/or experience in this area	Leadership/Teamwork 2: I have moderate skills and/or experience	Leadership/Teamwork 1: I have limited or no skills and/or experience in this area
Strategic Thinking/Planning	Strategic Thinking/Planning 4: I am a subject matter expert in this area (i.e. paid for my skills, knowledge and experience)	Strategic Thinking/Planning 3: I have significant skills and/or experience in this area	Strategic Thinking/Planning 2: I have moderate skills and/or experience	Strategic Thinking/Planning 1: I have limited or no skills and/or experience in this area
Critical Thinking/Problem Solving	Critical Thinking/Problem Solving 4: I am a subject matter expert in this area (i.e. paid for my skills, knowledge and experience)	Critical Thinking/Problem Solving 3: I have significant skills and/or experience in this area	Critical Thinking/Problem Solving 2: I have moderate skills and/or experience	Critical Thinking/Problem Solving 1: I have limited or no skills and/or experience in this area

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* 7. In addition to demonstrating a broad range of skills, knowledge and experience, the board as a whole should also encompass desirable diversity in aspects such as gender, age and different perspectives that are representative of the partners we work with and/or the communities we serve. Please share how you feel you would contribute to the diversity of the Foundation Board:

Leduc Community Hospital Foundation

4210—48 Street
Leduc, AB T9E 5Z3
Phone 780-980-4536
Email info@lchfoundation.ca
Web lchfoundation.ca

CRA Charity # 13913 8002 RR0001