Board Membership Application
Name: _____________________________________________________________________
Address: ___________________________________________________________________
City: _________________________________ State: __________ Zip: _________________
Phone: __________________ Alt Phone: ___________________ Mobile: _______________
Email: _____________________________________________________________________
Present Occupation: __________________________________________________________
Employer: __________________________________________________________________
Address: ___________________________________________________________________
City: _________________________________ State: __________ Zip: _________________
The MMHA uses email to send meeting notices, agendas and announcements to the Board of Directors. Please indicate your understanding of this practice, and your willingness to receive communication via email:
_____ Yes, I agree to receive Board Communication from the MMHA via email. I understand that this helps to reduce costs and agree to monitor my email regularly. I will notify the MMHA office as soon as possible if I am unable to access my email, or if my email address changes.
Education: Please list any special education and/or training that will support your role as a Board Member of the MMHA:
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Mental Health Involvement: Please list any other mental health organizations in which you have been involved and how those may compliment your role as a MMHA Director.
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Public Relations/Marketing: Please list any experience you may have in public relations, public speaking, broadcast or print media, or marketing:
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Financial Development: Please list any relevant experience you may have in fund raising, financial planning, recruitment, grant writing, or accounting.
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The Bylaws require a minimum of 4 Board of Directors meetings per year. In addition, the Board attends a Strategic Planning Retreat and the Annual Meeting each year. Please indicate your willingness to meet these requirements by initialing below:
_____ Yes, I agree to attend the meetings required as a Director. I understand that if I am unable to attend, I must contact the MMHA office or Board President for an excused absence. Failure to attend may result in my being removed from the Board.
The Bylaws require that all Directors be Members of the Montana Mental Health Association. Please indicate that you understand this requirement by initialing below:
_____ Yes, I understand I must be a Member in good standing with the MMHA in order to be considered for the position of Director. If I am not currently a Member, I agree to join the MMHA within 30 days of my nomination to the Board. I further agree to remit my dues annually throughout my term as Director.
The MMHA has several standing committees and Board Members are expected to serve on a minimum of one. The Committees include Education, Public Policy, Communications, Development, Membership and Children’s Committees. Please indicate your willingness to participate in at least one committee by initialing below.
_____ Yes, I agree to serve on at least one standing committee of the MMHA. I would like more information on the ________________________________________________________________________ Committee(s) (see the website for a description of each Committee).
Your Role: Please provide a brief summary of your understanding of your role as a Board Member and a short description of what you hope to add to the MMHA. Please include what you hope to gain from this experience:
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Please check any of the topics below where you have experience or special interest:
___ Advocacy
___ Communications
___ Coalition Building
___ Business Relations
___ Education
___ Consumer/family issues
___ Finance & administration
___ Planned giving
___ Legal issues
___ Training
___ Strategic Planning
___ Public policy
___ Financial development
___ Minority concerns
___ Cultural diversity
___ Corporate giving
___ Public relations/image
___ Hospitals
___ Childhood mental illness
___ Community M/H services
___ Prevention
___ Research
___ Serious mental illness
___ Support groups
___ Rehabilitation
___ Treatment services
___ Insurance
___ Patient rights
___ Fund raising
___ Organization structure
___ Leadership development
___ Administration
Personal references: Please list at least 3 with phone numbers.
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Signature of Applicant: Date: ______________________________________________________________________
THANK YOU FOR BEING PART OF THE SOLUTION!
Chapters in:
Daniels County
Great Falls
Sheridan County
Sweet Grass-
Stillwater Counties
An Affiliate of the National Mental Health Association
417 Central Ave #301, Great Falls, MT 59401 * P.O. Box 6133, Great Falls, MT 59406
406-727-MMHA (6642) * Toll free 1-877-927-MMHA
www.MontanaMentalHealth.org * info@MontanaMentalHealth.org