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Board Application

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*indicates required fields

General Information

*Name:

*Address:

*City:

Suite/Unit Number:

*Postal Code:

*Province:

*Email:

Home Phone Number:

*Cell:

Alternate Contact Phone #:

*Please indicate preferred contact number:
HomeCellAlternate

 


Attestation of SCIO’s Board Member Attributes

*Please indicate Yes or No beside each question

Integrity, Ethics & Confidentiality YesNo
Do you demonstrate integrity, high ethical standards and respect for privacy and confidentiality?

Business Acumen YesNo
Can you recognize and assess business risks and strategic opportunities?

Governance/Board experience YesNo
Do you have experience serving on boards,committees or organizations?

Communication Skills YesNo
Do you have strong verbal and written communications skills?

Experience in formulating policy YesNo

Experience in thinking strategically YesNo

Knowledge of organizational performance mechanisms and ability to monitor, evaluate and report YesNo

Conflict of Interest YesNo
Are you able to take all steps to avoid activities, behaviours or relationships that would constitute a conflict of interest

Respectful Conduct YesNo
Are you able work collaboratively and respectively with fellow Board members?

Availability to fulfill responsibilities on Board and committee YesNo
Do you have sufficient time, interest and availability to devote to performing the duties of Director as described in the SCIO Director Job Description?
Are you willing and interested in serving on at least one Board Committee?
 


Self-Assessment of Board Competencies

This is a brief survey of the skills, experience and knowledge required by the SCIO Board of Directors. Please select the options which best reflect your current areas of expertise. This inventory, once completed, will serve to determine the Board’s needs for possible additions to the Board.

1 = Area of Personal Expertise
2 = Significant Practical Experience
3 = Some Practical Experience
4 = Little to No Practical Experience

Disability Knowledge/Personal Experience with spinal cord injury (SCI) 1234

Financial/Investment 1234

Business Management 1234

Fundraising 1234

Government Relations/Public Policy/Advocacy 1234

Health, Community, Social Service Sectors 1234

Legal/Regulatory 1234

Performance Management, Quality, Risk Management 1234

Marketing & Communications 1234

Strategic Planning 1234

Human Resources/Labour Relations 1234

Human Rights/Equity 1234

Governance/Board 1234
 


*Please describe how SCIO would benefit from your participation on our Board:


 


Résumé of your experience and qualifications

*Please attach a current résumé in PDF format indicating your employment history, previous board directorships, relevant certifications, key accomplishments, etc.


 


 

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