Sample Application for Membership

Note: the following is intended to be an example that boards should adapt to meet their individual needs.

1. Instructions

(a) To apply to be a member of the [name of hospital] Board of Directors, you must complete this form and submit it with a copy of your current resume or a brief biographical sketch.

(b) Please submit your completed form and resume or biographical sketch by mail, fax, or e-mail [if the hospital is accepting applications on-line] to the following address: [Hospital address with fax number and e-mail address]

(c) The deadline for applications is [date of deadline]

(d) For more information about the application process, please contact: [Name and contact information]

To