Below is our Board of Directors application form. If you would rather submit your application by mail or fax please click here, otherwise please fill out the form below and you will be directed to the second part of the application.

Full Name:
Address:

City/Town:		Postal Code:
Phone Home:		Phone Business:

Email Address:

How did you hear about our organization?	unselected newspaper brochure phone book speaking engagement referral other
If you were accepted on the Board of Directors what area would you be interested in?	unselected newspaper brochure phone book speaking engagement referral other

Please share experiences and qualifications in the above areas or would you like to be involved in a different area. Please explain:

What appeals to you about any of the positions you have indicated? What do you fell you can bring to this organization?
What is you present occupation, or what previous jobs have you held?
What organizations {if any} have you joined in the past and how did you contribute?
Educational Background:	unselected Secondary Post Secondary present or planned training fluent in other languages	Please be spefic......
I agree to have a Security Clearance Check done by the Durham Regional Police?		unselected yes no
Have you ever used our services?		unselected yes no

I agree to sign a Document of Confidentiality regarding our organization?	unselected yes no
Please feel free to comment o this process or the organization to indicate the need for further information/clarification, or to provide us with additional information, etc. {Your feedback is valuable and is greatly appreciated}.

Please Include 2 references: 1 personal and 1 professional

Please note we will be contacting references by mail. Please ensure addresses are complete {i.e. with apartment numbers and postal codes) Thank you.

Professional Reference:

Full Name:
Address:

City/Town:		Postal Code:
Phone Home:		Phone Business:

Personal Reference:

Full Name:
Address:

City/Town:		Postal Code:
Phone Home:		Phone Business:

For security reference, please type your last name and postal code. {i.e. SmithA1B2CD}