Board of Directors Candidate Application
Food4Kids Waterloo Region
Susan Cook-Scheerer, Board President
10 Washburn Drive, Unit 4
Kitchener, ON N2R 1S2
Date *
Applicant Name (First, Middle, Last, Familiar Name) *
Address *
Phone *
E-mail *
Employment Details
Employer Name *
Your Title *
Address of Employer *
Employer Phone Number *
Employer E-mail *
Type of Business or Organization *
Primary Service(s) and Area/Population Served *
Number of Years Employed *
Preferred Method of Contact *
Please List Boards and Committees that you serve on, or have served on
(business, civic, community, fraternal, political, professional, recreational, religious, social).
Organization, Role/Title, Dates of Service *
Education/Training/Certificates *
Optional – Have you received any awards or honors that you’d like to mention?
How do you feel Food4Kids Waterloo Region would benefit from your involvement on the Board? *
Skills, experience and interests (Please circle all that apply) *
Please list any groups, organizations, or businesses that you could serve as a liaison (champion) to, on behalf of Food4Kids Waterloo Region.
Please tell us 3 personal reasons you would like to be on the Board of Directors. *
Reference #1 (Name, Relationship to you, E-mail, Phone #) *
Reference #2 (Name, Relationship to you, E-mail, Phone #) *
Reference #3 (Name, Relationship to you, E-mail, Phone #) *
Thank you for applying for a position to the Board of Directors, Food4Kids Waterloo Region. We will contact you within 24 hours of receipt of the application to confirm receipt and the process for selection.
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