COMMITTEE/BOARD APPLICATION FORM
Thank you for your interest in joining a nonprofit board!  Use this form to provide useful information about yourself, to ensure the best match between you and current ALT Mental Health board members.  The following information will be shared:
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Name *
Contact info *
Preferred way to be contacted between 9:00 am and 5:00 pm? *
Email address *
May we add you to our email list?
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If you join the Board, you agree that you can provide at least 2-4 hours quarterly in attendance to Board and Committee meetings, You can have 2 excused absences each rolling 12 months. Do you feel you can make this time commitment? *
Gender
Race/Ethnicity:
Can we assist you with any special accommodation (such as transportation assistance, wheelchair accessibility, or translation services) to help you participate fully on the Board?
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I need assistance with:
What is/are your preferred speaking language(s)?
OPTIONAL: Do you identify as belonging to any of the following groups
Check ALL that apply
Do you identify as a person with a disabilty 
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Do you identify as a person in the LGBTQIA+ community
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Briefly describe why you would like to join our Board *
Have you ever attended a meeting of this committee/board? *
Which of your skills would you like to utilize on the Board?  
List your involvement on other boards, organizations, school and/or neighbourhood groups, whether in the County or another community. Include any offices held. *
Employment experience (pertaining to any skills or experience relevant to this application): *
Please submit your resume to: connect@asyluma.org
Educational Background: *
Procedural fairness in the activities of a public body may require board/committee members to disclose any personal or financial interests. Board/committee members may also need to abstain from participating in any matters in which they or their families, friends, or businesses have a real or perceived financial or personal interest in the outcome of deliberations
Are you aware of any potential conflicts of interest or perceptions of bias which may arise from your personal or financial interests or those of your family, friends, or businesses? If so, please indicate any potential conflicts: *
How did you learn about our Asylum Advocates?
What would you like to get for yourself out of your participation on the Board, e.g., what types of experiences, skills to develop, interests to cultivate for you, etc.? *
Please describe any formal or informal Mental Health education you have received
What experience have you had working in diverse groups? *
The Board is a very diverse group and teamwork allows the Board to conduct business efficiently and enables it to successfully fulfill its mission. Please tell us about your experience as a member of a team. *
Members of the Board may choose to share personal information and experiences during our meetings, or in conversations. The Board considers these discussions private and personal. Describe how you have managed confidentiality issues in the past. *
The Board meetings can sometimes be stressful and emotional. Describe a situation in which you have had to deal with someone who was critical or unpleasant and tell us what you did to ensure a positive outcome for both you and everyone else involved. *
Other comments you’d like to share
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