Board Member Application

form.antibot * :not(.antibot-message) { display: none !important; }You must have JavaScript enabled to use this form.

Personal Information

Given Name(s)

Last Name

Email Address

Phone Number (day)

Phone Number (Night)

Address Number

Address Street

Apartment Number

City

Province

Postal Code

Motivation and Skills

1. Why do you wish to be a Board of Directors member?

2. What skill set can you contribute to Board governance?

3. From a personal growth persepctive, what are you hoping to gain from being a member of the Board of Directors?

Personal References

Name

First Reference

Address

Phone Number

Second Reference

Name

Address

Phone Number

Third Reference

Name

Address

Phone Number

Acknowledgement

If selected as a Board of Director volunteer, I agree to make a time commitment, abide by all policies and procedures of the organization and treat all matters of Community Living Sarnia/Lambton as confidential, particularly information relating to the personal lives of people supported. I authorize my references to furnish information and release them from any and all liability on account of having furnished such information. I also acknowledge that if I am selected as a Board of Director volunteer, my membership is conditional upon satisfactory police clearance, namely, a criminal reference check including “Enhanced Criminal Reference Check or Vulnerable Sector Screening Report”.

Do you agree with this acknowledgement?

Yes, I agree to the above acknowledgement.

Volunteers have a rich history and play an integral role in the supports and services provided by Community Living Sarnia/Lambton. Thank you for your interest in joining our Board of Directors.

Community Living Sarnia-Lambton’s employment model has been shared and adopted by other communities across Ontario and even internationally.

Vision: A community where everyone is valued and can participate.

Volunteers are the bridge between the community and the services that we provide

Community Living Sarnia-Lambton has grown to support more than 400 children and adults with developmental and intellectual challenges.