Board of Directors Application

Name of Candidate:(Required)

First Last

Candidate Email Address:(Required)

Enter Email Confirm Email

Candidate Phone (Work or Cell):(Required)

Company:(Required)

Location in California:(Required)

Position:(Required)

Area of Interest within rural health:(Required)

Experiences, expertise or resources you would bring to the board:(Required)

Briefly describe why you would like to join our Board of Directors:(Required)

Board Experience:(Required)

Current organizational affiliations (names of the companies and your role(s):(Required)

Short Bio:(Required)

Professional References:(Required)

CSRHA Board of Directors Application