MENTAL HEALTH ASSOCIATION in HENDRICKS COUNTY

MENTAL HEALTH AMERICA

of HENDRICKS COUNTY

BOARD CANDIDATE

BOARD CANDIDATE NOMINATION FORM

As a prospective candidate for the MHAHC Board of Directors, fill in the following information and submit to the MHAHC office. Upon acceptance of the nomination, you will proceed through the orientation requirements to be documented on the back of this form (page2). When orientation is completed, the Board of Directors will vote on your appointment. Thank You for your interest !!!

Name: ___________________________________________________________________

Home Address: ____________________________________________________________

City: _____________________ State: ____________ Zip Code: ___________

Skills of Interest to MHAHC: _________________________________________________

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Other Active Community Involvement: ___________________________________________

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Current Interest in MHAHC: ___________________________________________________

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Board Activities that Interest You (to be completed at orientation meeting)

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List two (2) Community/Personal References (Names and Phone Numbers)

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Signature: ________________________________________ Date: _______________

ORIENTATION REQUIREMENTS

Attendance at two (2) Board Meetings:

Dates Attended: ____________ ____________

Assistance at two (2) MHAHC Fund Raising or MHAHC Community Activities:

Date: _____ Activity _______________ Date: _____ Activity: _______________

Orientation Meeting with One of the Following: (including Board Packet discussion) Board President, Immediate Past President, Chairman of Board Development Committee.

Date: _______ With Whom: ________________________________________________

Committee Selection (to be completed at Orientation Meeting)

_____ Board Development Committee

_____ Finance Committee

_____ Program Committee

_____ Community Relations Committee

Volunteering Orientation Meeting with One (1) of the following:

Volunteer Coordinator, Executive Director MHAHC

Date: _______ With Whom: ________________________________________________

MHAHC Membership Monetary Contribution

Date: _______

Board Approval

Date: _______

Board Mentor/Sponsor: _____________________________________________________

We welcome any comments or suggestions you may have concerning the nomination/orientation procedure for prospective Board members:

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