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mental health and addictions crisis number

Join Our Team

Board Application

General Information - please review

  1. Principles of Governance and Board Accountability
  2. Roles & Responsibilities of the Board
  3. Director/Officer Recruitment
  4. Committees of the Board


Please read and agree to the following:

  1. Statement of Qualifiers for Board of Directors and Committee Members
  2. Code of Conduct - Check back soon, under development
  3. Conflict of Interest Policy

If you prefer to fill out the form through a Word document you can download it here.

Board Application Form

Rate your skills/experience from 0-3 (0=none; 1=fair; 2=good; 3=advanced) for each of the following:
Governance Experience*
Business Management*
Human Resources Management*
Government and Government Relations*
Strategic Planning*
Construction and Project Management*
Mental Health & Addictions Needs of our Region*
Risk Management*
Information Technology*
Change Management and/or Collaboration*
Quality and Performance Management*
Client and Mental Health and Addictions Care Advocacy*
Policy Development*
Public Affairs and Communication*
Equity, Diversity and Inclusion Initiatives*
Demographic Information (Note: this information will be reported in aggregate, not individually) Please respond using wording that you are comfortable with.
Member of a/an First Nation(s) and/or Indigenous Community:
Validation Code



United Way Leeds & Grenville         Ontario ministry of the Attorney General         Ontario Ministry of Health and Long-Term Care         Ontario South East Local Health Integration Network