Board Interest Form

First and Last Name *

Email Address *

District *

Title *

Join the ACHD Board by submitting a resume or statement of qualifications to ACHD. The Governance Committee will review and recommend candidates to be approved by the full ACHD Board.

Please note the criteria for serving on the Board is as follows:

No member district may be represented on the Board by more than one voting director at the same time.
The nominee's healthcare district is either currently a “Certified Healthcare District” or commits to becoming certified within the first three years on the Board.
The district board of directors, on which the nominee serves, must support the nomination in writing at the time of submission.

Individual directors serve three-year terms, up to two terms, and their appointment becomes effective upon approval by the ACHD Board.

A Letter of Support is required from a member of your district's Board of Directors. Please reach out to them and have them send the signed Letter of Support to ACHD at cathy.martin@achd.org. *

I have notified a member of my Board of Directors for a Letter of Support.

Statement of Qualifications:
The following questions serve as a Statement of Qualifications. On a separate page, please provide clear and detailed responses.

List and briefly describe any current or prior service on the ACHD Board of Directors or ACHD Committees.
Describe the contributions you have made in programs, initiatives, etc., that have positively impacted your healthcare district locally and/or statewide.
How have you demonstrated professional, business, or political leadership in your community?
Please list three qualities of an effective healthcare district Leader.
Please note any potential conflict of interests that should be disclosed.

Please upload your Statement of Qualifications here:

An alternative form instead of the Statement of Qualifications is to submit a resume. Please upload your resume here:

Please Sign *

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