This form will take approximately 15-20 minutes to complete.

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* 1. SURNAME

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* 2. FIRST NAME

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* 3. TITLE

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* 4. PROVINCE/TERRITORY

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* 5. FCM MUNICIPAL MEMBER (Complete relevant category)

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* 6. Confidential to the FCM Chief Elections Officer & Elections Committee:

I, the undersigned, do hereby consent to have my name submitted for consideration as a member of the Board of Directors of the Federation of Canadian Municipalities.

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* 7. I am an elected municipal official holding office with an FCM Municipal Member in good standing.

RESOLUTION INFORMATION:

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* 8. I am attaching a copy of a resolution from my municipal council, or Provincial or Territorial Municipal Association (for PTA representatives), authorizing me to stand for election as a representative on FCM's Board of Directors.

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* 9. Resolution expiry month:

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* 10. Resolution Expiry Year:

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* 11. I understand I will not be considered as a candidate in the FCM Board of Directors election if I do not submit my resolution by the relevant deadline in question 8.

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* 12. Upload your resolution.

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

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* 13. I confirm that my municipal council, or supporting Association, is prepared to incur any cost related to my attending meetings of FCM's Board of Directors.

CONTACT INFORMATION:

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* 14. PHONE NUMBER

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* 15. E-MAIL

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* 16. Are you marking a milestone Year of Service on the FCM Board?
(Please select from the dropdown list)

ELIGIBILITY AND CONSENT

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* 17. Qualifications of directors - Canada Not-for-profit Corporations Act (section 126 (1))

The following persons are disqualified from being a director of a corporation:

- anyone who is less than 18 years of age;

- anyone who is incapable;

- a person who is not an individual; and

- a person who has the status of a bankrupt.

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* 18. I have read and agree to abide by the FCM Code of Ethical Contact, Harassment Policy, and Anti-Racism and Equity Commitment Statement.

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* 19. Do you consent to share your contact information with other FCM Board and Committee members?

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* 20. Signature
By checking this box you provide consent for your nomination to be brought forward.

NOTE:
Nominations from the floor will not be accepted.
COMMITTEE PROFILE INFORMATION

Should you be elected to the FCM Board of Directors, the expectation is that you will serve on at least two committees. As set out in FCM bylaws, the FCM President makes committee appointments based on directors' experience, expertise and interests, as well as the need to balance regional, community size and demographic representation on each committee. The following questions will assist with the committee appointment process.

We are also gathering demographic and board skills information to better understand the make-up of the Board of Directors, and to plan for ongoing skills and capacity training needs.

All personal information you provide will be securely stored in our office, long-term secure storage facility, FCM secure cloud environment or an ITS-approved vendor. As part of these precautions, we restrict access to personal information to Authorized Users and, we will never share your information with a third party without your consent. In addition, all personal user information is stored behind a firewall. The data will never be reported individually; any data shared from this survey will be done so only in aggregated form.

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* 21. Community Size 
What is the population of the municipality you represent on the FCM Board?

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* 22. How many years have you been a municipal elected official?
(Please select from the dropdown list)

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* 23. How many years have you served on FCM's Board?
(Please select from the dropdown list)

FORUMS AND NETWORK

FCM’s Northern and Remote Forum, Rural Forum, and Network of Francophone Municipalities are composed of members identifying with those specific interests. Please tell us:

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* 24. Would you consider your community to be rural in nature or have a significant rural component or a significant rural interest?

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* 25. Is the municipality you represent on the FCM Board part of a Northern or remote community?

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* 26. Would you like to be actively engaged in encouraging greater participation of members that share the use of French, and informing FCM on priority issues for Francophone communities across the country?

DEMOGRAPHICS

The following information is meant to help provide baseline data to track and understand diversity and representation on the Board. This data will remain confidential.

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* 27. Which of the following best describes your gender?

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* 28. What is your age range?

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* 29. In which official language are you fluent?

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* 30. Indicate all the following that relate to your racial identity:
(Select all that apply)

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* 31. Do you belong to an equity-seeking group other than race and/or gender?

(Equity seeking groups are those that identify barriers to equal access, opportunities, and resources due to disadvantage and discrimination and actively seek social justice and reparation. e.g.: Recent immigrants and refugees, persons with disabilities, 2SLGBTQI+ people)

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* 32. If you answered YES to question 30, with what group or groups do you most identify?
(select all that apply)

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* 33. What is your mother tongue?

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* 34. What is the highest level of education you have completed? 

INTERESTS AND EXPERTISE

Next please indicate your areas of interest (areas where you have expertise, lived experience, or areas that you are hoping to become more engaged in). Committee appointments will be based on area of interest as well as balance of board and non-board representatives across demographics, experience and region. Committee members receive advocacy updates, review strategic priorities, and make recommendations to the Board of Directors.

Committees are the place for more in-depth analysis of issues than is possible at the full Board of Directors. Members are expected to bring their experience and engagement to deliberations in order to provide the best possible advice to the Board. Simultaneous interpretation will be provided at all the standing committees.

(For each of the following choices, please select one)

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* 35. Anti-racism, equity and inclusion work in municipalities

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* 36. Community safety and wellbeing (including RCMP)

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* 37. Addressing mental health, substance use and addictions

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* 38. Developing a new growth (fiscal) framework for Canadian municipalities

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* 39. Addressing homelessness and affordable housing

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* 40. Public transit (rural and inter-community bus services, urban public transit)

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* 41. Municipal infrastructure, including water infrastructure, transportation infrastructure and community, culture and recreation facilities

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* 42. Linkages between federal housing, infrastructure, and transit policy

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* 43. Climate change – Reducing GHG emissions and achieving Canada's 2030 and 2050 climate targets

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* 44. Climate change – Climate adaptation, disaster mitigation and climate-resilient infrastructure

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* 45. Environmental stewardship, conservation, natural infrastructure and land-based solutions to tackling climate change

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* 46. Issues specifically impacting Canada’s north (northern infrastructure, housing, climate adaptation/mitigation, broadband)

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* 47. Issues specific to rural municipalities (broadband, housing, infrastructure, inter-community transportation)

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* 48. Advancing Reconciliation and Indigenous priorities in your municipality

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* 49. Political and policy engagement with Indigenous communities, organizations and leaders

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* 50. Other, please specify:

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* 51. Please provide any relevant information regarding your experience:

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* 52. Committee Participation

Finally, please tell us about your experience or expertise with the following relevant board skills.
(Select all that apply)

  Expert/Very Experienced Moderate/Some Experience No Experience
Chairing meetings
Inclusive chairing best practices
Understanding and applying Roberts Rules of Order during meetings
Financial reporting, internal or external audit, treasury board, financial and audit committee, monitoring fiscal health, risk management
Planning and monitoring human resources policies and practices
Governance best practices such as developing/reviewing board policy or terms of reference
Thank you.

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