Interest Form: Lyon Martin Board of Directors
“Help us take care of our community - this work makes a difference!” — Angela, Board President 

~~~~~Role description~~~~

Board members will attend one or two monthly meeting to discuss the governance and strategy of Lyon Martin Community Health Services.  Meetings are on Zoom and run 1-2 hours in length - currently scheduled for Tuesday evenings.  Expect about 1-4 hours of admin work per month.  If you have additional time and skills to share, then the sky’s the limit!

~~~~~~~$$$$$~~~~~~~~

Financial Compensation: none

Reasonable reimbursement for costs of participation and/or accommodations subject to board approval. 

~~~~~Member Qualities ~~~~

A majority of the Board will reflect the demographics of the patients served (Black, Indigenous, or People of Color (BIPOC)); a majority of the Board will identify as marginalized sexual identities such as Lesbian, Gay, Bisexual,  Pansexual, Queer, Asexual, BDSM; and a majority of the Board must be of Trans, Non-Binary,  Gender Non-Conforming or Intersex (TGI) experience since this is the population being served.  People of the above demographics who also have disabilities or chronic illnesses, are formerly incarcerated, undocumented, unhoused, or are current or former sex workers may be prioritized.

At least 51% of Board members must be clients/patients of Lyon Martin. This is defined as having a clinical appointment at Lyon Martin within the past 24 months.
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Email *
First Name(s)
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Last Name(s)
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Pronouns
*
Required
Telephone Number
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What is the best way to contact you?
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Required
What days/times are you generally available for an interview? (Check all that apply)
8am -- 12pm
12pm -- 5pm
5pm -- 9pm
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays
Are you a patient at Lyon Martin Clinic AND have you visited the clinic in the last 24 months? (Not a requirement for board service)
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Do you identify as BIPOC?
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Do you identify as LGBTQ?
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Do you identify as transgender, non-binary, gender nonconforming, and/or intersex?
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Do any of the following identities/experiences apply to you now or at any point in your life? (Choose all that apply)
Do any of the following skills/experiences apply to you? (Choose all that apply)
Are you a current employee or subcontractor of the City and/or County of San Francisco?
*
What are your access needs? What accommodations would help your ability to participate fully on the Board? *
Required
Why are you interested in joining the Board of Directors for Lyon Martin?
*
A copy of your responses will be emailed to the address you provided.
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