Request for Appointment to CSDHH Board of Directors
All Board meetings are held on Tuesday evenings starting with an open session at 6:00 pm at the CSDHH office, Suite 15 Conference Room. Food and refreshments are provided for all attending Board members and staff. The Board does not meet over the summer, June – July.

Please complete the form below, which will be submitted to Kelle Owens, Executive Director. Please also email her directly with your resume and any additional relevant information at kelle@csdhh.org

Personal Information
Full Name: *
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Address: *
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City: *
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State: *
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ZIP Code: *
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Email Address: *
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Home Telephone: *
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Business Telephone: *
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Gender:
This is optional, leave blank if you choose not to identify
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Race:
This is optional, leave blank if you choose not to identify
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Age:
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Employment
Current Employer: *
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Current Job Title/Position: *
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Length of Time with Employer: *
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Background Information
List Professional Activities:
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List Volunteer Activities:
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How long have you been a resident of Guilford County? *
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What do you feel are your qualifications for serving on the board, committee, or commission requested?
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State any other training and/or participation in the community which you feel would enable you to serve on this board or commission.
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Please list any other boards or commissions in which you have an interest, and related qualifications.
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