2022 Board Member Application

Please complete the following application form and submit a current résumé.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Home Phone

Business Phone

Cell Phone(Required)

Employment Status(Required)

Employer Name(Required)

Employer Phone(Required)

Employer Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Health Forward directors are expected to attend board meetings regularly and actively participate on at least one board committee. Are you willing to make a three-year commitment to serve on the board and meet the minimum 60 percent attendance requirements for both board meetings and committee meetings?(Required)

Conflict of Interest(Required)

Are you willing to comply with Health Forward's Conflict of Interest policy?

Do you receive any monetary benefit from Health Forward?(Required)

Please explain the nature of your monetary benefit from Health Forward:(Required)

Please write a brief statement that explains your interest in serving on board to advance its mission of providing leadership, advocacy, and resources to eliminate barriers and promote quality health for uninsured and underserved in our service area.(Required)

To determine if you fit certain criteria, refer to this document for more detailed definitions of the following categories.

Select all that apply to your expertise, education, or experience in the following areas(Required)

Accounting/auditing: Ability to understand and analyze financial statements, budgets, and audits, and to ensure that items are reported correctly

Behavioral health: Professional clinical experience in the provision, research, or evaluation of behavioral health and substance use disorder treatment and services

Communications: Professional experience in public relations and in developing and executing communication strategies

Community-based organizations: Professional experience advancing a community through health, human services, education, civic participation, vocational development, advocacy, or socio-economic conditions

Diverse-abilities expertise: Professional or personal experience in educating or training individuals with mental, intellectual, and physical diverse-abilities

Economic and workforce development: Professional experience enhancing a region's economic stability and prosperity by focusing on people rather than businesses

Education: Professional experience in academia, including K-12 and higher education settings

Equity, diversity, and inclusion: Experience addressing systemic and structural marginalization, and developing and executing racial justice strategies

Government: Professional experience in government, preferably in the health and human services, housing, or educational arenas

Health care/delivery: Professional education, training, and clinical or administrative experience in health care delivery systems, especially for uninsured and underserved communities

Housing or community development: Professional experience with place-based initiatives and developing and implementing strategies that result in safe and affordable housing

Investment management: Professional education, training, and experience in institutional investment, financial management of securities, and endowment management

Legal: Possesses a law degree and current board certification, and is practicing/has practiced law

Organizational management: Professional experience in strategic planning, organizational development, fiscal planning and management, talent development, and management

Public health: Professional experience promoting healthy lifestyles; researching disease and injury prevention; detecting, preventing, and responding to infectious diseases; and limiting health disparities

Public policy: Professional experience in lobbying, advocacy, and shaping public policy in the area of health and human services

Real estate: Professional background in commercial real estate development in opportunity zones and using public financing in Kansas City

Research/evaluation: Education and training in researching and analyzing data to inform decisions and assess outcomes

Rural issues: Experience and understanding of the challenges and barriers to quality health care access and healthy living within the rural community.

How would your expertise benefit you in assisting the board of directors with meeting the unmet needs of the community?(Required)

Describe your previous board experience.(Required)

In which county do you reside?(Required)

Are you a taxpayer, business owner, or property owner in any of the following Kansas counties?(Required)

The following questions should not be construed as restrictions that may exclude anyone with past judgment(s) from serving on our board. Responses will not disqualify any individual from nomination consideration.

Have you ever been arrested for or convicted of a felony?(Required)

Please explain the nature of your felony arrest/conviction.(Required)

Have you ever had or is there currently a judgment against you?(Required)

Please explain the nature of the judgment against you.(Required)

Diversity, equity, inclusion, and belonging are important values of Health Forward Foundation. Accordingly, the following demographic questions are required so that we may track such data and hold ourselves accountable to our values.

Race/ethnicity(Required)

Black/African American/African

Asian American/Pacific Islander/Asian

White/Caucasian/European

Hispanic/Latino/Latina/Latinx

Native American/American Indian/Indigenous

Race/ethnicity not listed (Please specifiy)

Race/ethnicity not listed (Please specify)(Required)

Gender(Required)

Female

Male

Gender identity not listed (Please specify)

Gender identity not listed (Please specify)(Required)

Age(Required)

18-39

40-64

65+

Statement of Commitment: I am fully prepared to dedicate the time and energy to serve on the Health Forward Foundation Board of Directors. I will attend meetings regularly and serve as an active and involved member of the board. I will serve with the utmost integrity and sensitivity to the health care needs of the community. I have no conflict of interest in serving on the board of directors and no history of activities, illegal or otherwise, that would cause embarrassment to the board. The information that I have submitted in this application is true and accurate to the best of my knowledge.

Consent(Required)

I agree to the terms.

Upload Resume(Required)

Please upload your résumé using the button below. Résumés should be a PDF file. It should not exceed 5 pages or 15mb in size. If you have issues with uploading your document, please contact boardapplicants@healthforward.org or call Health Forward at (816) 241-7006.

Accepted file types: pdf, Max. file size: 15 MB.

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