Board of Directors Candidate

Candidate Name*

Address*

Street Address Address Line 2 City Province Postal Code

Email*

Phone*

Occupation*

Candidate is: (please check one)*

Family Member (Parent, spouse, sibling, child or loved one of someone with a serious mental illness)
Primary Consumer (An individual with a diagnosis of mental illness)
Mental Health Care Provider

Areas of Knowledge/Expertise/Influence*

Please select all that apply

Why are you interested in AMI? And why now?*

What is your experience/familiarity with AMI-Quebec?*

List previous volunteer and/or board member experience:*

List outside interests that may be relevant to the AMI-Quebec mission:*

What does the candidate bring to AMI-Quebec?*

If filled out by person other than candidate, please note this page is confidential and will not be shared with candidate.

Candidate proposed by*

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Phone

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Board of Directors Application Form