HCCA Board Member Application
Healthy Communities of the Capital Area board members are individuals who will help carry out the organization's mission to convene and support individuals, organizations, and communities to collaborate on quality of life and public health issues. HCCA partners with local people and organizations who work to improve the health and quality of life in southern Kennebec County.

As a group, HCCA board members provide strategic guidance, are representative of different geographic areas across HCCA's local service area, represent different demographics, and possess skills, expertise, and lived experience to help the organization thrive. Guiding the organization are the Community Health Improvement Plan priorities and the organizational strategic priorities that can be viewed on HCCA's website (link below).

Please complete the application below by March 12, 2021. Potential new board members will be invited to attend HCCA's March 22, 2021 board meeting 3:00-5:00 via Zoom.

Please read over the board member roles and responsibilities to make sure it is a good fit for you: https://drive.google.com/file/d/1mX2hz7YrHflU7596sWKIOMBTtpotJjgN/view?usp=sharing

Learn more about HCCA (scope of work, values, staff, current board members, and more) at: https://www.hccame.org

For more information or if you have questions, contact Renee Page at r.page@hccame.org

Please tell us more about you and why you would like to serve as an HCCA board member.
Email address *
Last Name *
First Name *
Organization (if student, retired, or currently not working, what is your most recent professional affiliation) *
Position/Title (if student, retired, or currently not working, please tell us about your most recent and/or relevant work experience) *
Organizational Mailing Address (many of HCCA's partners, including funders, ask where board members physically work and reside)
Work Phone
Home Address (many of HCCA's partners, including funders, ask where board members physically work and reside) *
Home or Cell Phone *
Home or Cell Phone (additional/optional)
Preferred email address (how you would like to receive communcations from HCCA about meetings, events, advocacy, etc.) *
Email address for googledrive access and document sharing (HCCA uses googledocs for board meetings and materials) *
HCCA primarily serves southern Kennebec County, although some projects have a wider geographic reach. Where in southern Kennebec County are you based or do you carry out your work? Check all that apply. *
Why are you interested in serving as an HCCA board member? *
HCCA works to improve public health and quality of life, and does this by partnering with others on projects and initiatives. Many of the sectors HCCA has worked with are listed below. What sector do you represent (check all that apply)? Please feel free to add to this short list using the Other option. *
HCCA does a lot of work in primary prevention (defined as reducing the risk for negative health outcomes) in the areas listed below. Which of these areas in public health/community health do you feel passionate about and/or have experience (select all that apply)? Are there other areas of public health that interest you? *
What is your current and past involvement with HCCA (involvement in projects, participation on committees/task forces, partner in carrying out HCCA's work, etc.)? *
As a public health non-profit organization, HCCA must raise 100% of the funds required to support its community work including organizational operations, education and advocacy for public health issues, and staying apprised of current public health best practice. What skills, expertise, or perspective can you bring to HCCA to ensure organizational sustainability? *
HCCA's vision is: Happy, thriving, interconnected people, organizations, and communities who are empowered to improve their quality of life. What do you envision HCCA could accomplish, and how would you like to help? *
HCCA strives to attain diverse representation among staff and board members and is often asked for demographic information. Please share the following Optional Demographic Data. What is your gender identity?
Clear selection
Optional Demographic Data: Do you identify as LGBTQ+?
Clear selection
Optional Demographic Data: What is your age?
Clear selection
Optional Demographic Data: which race(s) do you identify with?
Optional Demographic Data: Do you identify as Hispanic or Latinx?
Optional Demographic Data: Do you identify as one or more of the following?
Clear selection
Optional Demographic Data: If you selected one of the above options, what is your country of origin?
Please provide a brief bio that will be featured on HCCA's website and may be included in grant applications when requested. Please highlight your interest and expertise in public health. Maximum 200 words. For inspiration, visit: https://www.hccame.org/about/board-of-directors/ *
Please share anything else you would like HCCA to consider.
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