Foundation Member Application Form

* Required fields
General Information
Interest in SCF

Please provide a brief overview of why you are interested in joining SCF. *

Education & Work Experience

Please provide a brief overview of your education and work experience (places of employment, position held, time frame, key responsibilities). *

Board and Committee Experience

Please list the Boards and Committees that you currently serve on or have served on in the past (church, business, community, professional, recreations, etc.)
Leave these fields blank if you do not have any board or committee experience.




Add Organization

Interest in Serving on SCF Board of Directors

Members of the SCF Board of Directors are recruited from the Foundation each year. Please indicate your interest in serving on the SCF Board of Directors. *




Skills/Giftings

The most effective Board of Directors is a board comprised of people with a variety of complementary skills and giftings. No one person is expected to be highly skilled or gifted in all areas; for example, not all Board members will be highly skilled in healthcare or in finance.

Please rate yourself on each of the following criteria using the scale below. For any item in which you rate yourself with a 1 or 2, please provide a brief description of the experiences that allowed you to develop the particular skill/gifting.

  1. Highly skilled/gifted
  2. Skilled/gifted
  3. Limited or not skilled/gifted

Effective Communicator


Change Agent


Team Player


Problem Solver


Governance


Business/Management


Healthcare


Regulatory/Legal


Finance


Strategic Planning


Information Technology


Human Resource Management


Quality Improvement / Risk Management


Other

Confidentiality Statement

Shepherd’s Care Foundation respects your right to privacy and takes seriously our responsibilities regarding the collection, use and disclosure of your personal information. Shepherd’s Care Foundation wishes you to be aware of the following information.

The information collected on this form is strictly confidential and intended solely for use by the SCF Nominating Committee. This information will not be reproduced or shared with SCF staff, churches or any other organization.

Consent

I consent to Shepherd’s Care Foundation collecting and using my personal information for the purposes identified above.

I certify the information I provide in this application is correct and true to the best of my knowledge. I understand that any misrepresentation may disqualify me from membership and/or result in dismissal at any point during my membership.