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* 1. Name

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* 2. Contact Information

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* 3. Education/Training/Certificates

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* 4. Professional Experience (check all that apply)

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* 5. Why are you willing to assume the responsibilities of the position of the Board Director?

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* 6. How will you have sufficient time and energy to devote to the performance of the duties of the Board Director position?

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* 7. In your personal and professional dealings, how do you demonstrate integrity, high ethical standards, and respect of privacy and confidentiality?

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* 8. Please share your experience serving on boards, committees, or volunteering for other organizations.

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* 9. Please share how you recognize and assess business risks and strategic opportunities.

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* 10. Please share any experience that demonstrates that you can conceptualize and think strategically and that you possess good problem solving and interpersonal skills.

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* 11. Please share how you demonstrate the ability to think, act, and speak independently and with conviction and confidence.

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* 12. Please share your oral and written communication skills.

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* 13. Please use this space to add any skills, capabilities, experience, resources, perspectives and/or attributes (not already covered above) that you will provide to the ICA and how ICA would benefit from your involvement on its Board of Directors.

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* 14. Please upload your resume.

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