Board of Directors Application

Online Application

Thank you for your interest in serving on Fenway Health’s Board of Directors! Any new applications will be considered for the new term that begins in July, 2023. Applications must not be submitted any later than March 1th, 2023. You can learn more about the specific responsibilities of a Board member at Fenway Health by reviewing our Board of Directors Job Description .

This is an application to serve as a volunteer member on the Board of Directors for Fenway Health.

Introduction
Fenway Health is a non-profit organization whose stated Mission is, to enhance the wellbeing of the LGBTQIA+ community and all people in our neighborhoods and beyond through access to the highest quality health care, education, research and advocacy. Federal regulations state that no board member shall be an employee of the health center or an immediate family member of an employee.

Please provide the requested information below.

* Required Field
Personal Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Gender/Pronouns*
Employment Information
Employer*
Title/Role*
Employment Address*
Length of Employment*
Briefly describe your background
1. Briefly explain (3-4 sentences) how you are connected with Fenway Health.*
2. Are you a patient of Fenway Health? Please check one. (Fenway Health is required to have at least 51% of its Board of Directors as “Consumer Directors”.)*
- Yes
- No
3. Briefly explain (3-4 sentences) why you are interested in serving on the Board of Directors for Fenway Health. How do you feel Fenway Health would benefit from your involvement on the Board?*
4. Briefly explain (3-4 sentences) what aspect of the Board of Directors role interests you the most.*
5. What skills and experience can you contribute to Fenway Health’s Board of Directors?*
6. What areas of expertise will you contribute to Fenway Health’s Board of Directors? (Check all that apply. CTRL (or Command for Macs) + click to select more than one.)*
7. Briefly describe any other areas of expertise or interests.*
8. Do you have any prior Board experience? If yes, please list the name of the organization, role(s) and years served.*
9. Are you currently serving on any other Boards? If so, which ones?*
10. What other professional or social organizations are you a member of?*
11. Please list any groups, organizations or businesses that you could serve as a liaison to on behalf of Fenway Health.*
12. Please list the names and contact information for three references: one professional, one personal, and one volunteer reference.*
13. Diversity and inclusion are important considerations for Fenway. As Fenway looks to find diversity among its Board of Directors, what would you bring as a candidate?*
14. Please tell us anything else you’d like to share.
Conflicts of Interest
Every member of the Board of Directors is required to make full disclosure of any and all actual, perceived, and potential conflicts of interest on an annual basis. Directors are also required to disclose a conflict of interest when it becomes known between annual disclosures. The failure to disclose a conflict of interest is reason for immediate dismissal from the Board of Directors. If your candidacy is put forward by the Governance Committee of the Board of Directors, you will be asked to complete a conflicts of interest disclosure.
Background Check
Every member of the Board of Directors is required to pass a background check before taking office. If your candidacy is put forward by the Governance Committee of the Board of Directors, you will be asked to go through a background check.

Interpretation Services Servicios de interpretación Serviços de interpretação 口译服务 Sèvis Entèpretasyon

Interpretation Services Servicios de interpretación Serviços de interpretação 口译服务 Sèvis Entèpretasyon

Become a Board Member

Online Application

Board of Directors Application

Introduction

Personal Information

Employment Information

Briefly describe your background

Conflicts of Interest

Background Check

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