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 Board of Directors Online Application




Step 2: The Application

Personal Information (* denotes a required field.)
* Applicant’s Name:
 		 * Daytime Phone:
* Street Address:
 Evening Phone:
* City, State and Zip:
(must be in Chapter territory - if you are uncertain if your address lies within the Chapter's territory, please contact Cindy Marsden at cindy.marsden@alz.org for list of counties served by the Chapter)
* E-Mail:
 Fax:
Current Position
Position/Title:
 From:
Organization:
 To:
Previous Positions
Position/Title:
 From:
Organization:
 To:
Position/Title:
 From:
Organization:
 To:
Position/Title:
 From:
Organization:
 To:
Other positions:
Current Volunteer Positions
(Alzheimer’s Association, Service Club Membership and/or Other)
Position/Title:
 From:
Organization:
 To:
Position/Title:
 From:
Organization:
 To:
Position/Title:
 From:
Organization:
 To:
Other positions:
Education (list most recent first)
Institution:
 Year:
Degree/Field:
Institution:
 Year:
Degree/Field:
Institution:
 Year:
Degree/Field:
Honors, Awards, & Special Recognition (list most recent first)
Given by:
 Year:
In Recognition of:
Given by:
 Year:
In Recognition of:
Given by:
 Year:
In Recognition of:
Applicant Self-Evaluation (* denotes a required field.)
* Commitment to the Association Vision, Mission and Strategic Plans:
Using the Association’s Vision and Mission statement and the Association’s strategic plans, please describe your interest in Board service.
(please limit your answer to 200-250 words.)

* Governance and Leadership Skills and Abilities:
Please describe your experience with governance and leadership. Please share your specific experiences with decision-making and leadership on relevant non-profit and for-profit governing boards as well as your skills in such areas as policy development, setting strategic direction, monitoring organizational effectiveness, overseeing a multi-million dollar budget, or determining critical legislative and/or programmatic policies.
(please limit your answer to 200-250 words.)


* Knowledge and Experience:
Please describe your professional and personal experience as it relates to Board service. Please share your knowledge and experience and how it will complement Board service in one or more activities such as public policy, programs and services, donor development and fund raising, volunteerism; communications and information technology, business and finance, or marketing and brand strategies. An understanding of Alzheimer’s disease and/or experience with the disease, either personally, with a loved one or professionally, is also considered.
(please limit your answer to 200-250 words.)


* Ability to Represent the Association to the Public:
Please describe your experience with public speaking and other ways in which you have been called on to communicate with diverse audiences such as the general public, media, professional audiences, law-makers, and government officials.
(please limit your answer to 200-250 words.)


* Time commitment:
Please be aware that Board members are expected to travel and participate in Board meetings, committee meetings, an annual retreat, an initial orientation, and fundraising events throughout the Chapter territory. Please describe how you will make this commitment.
(please limit your answer to 200-250 words.)


Self Assessment of Skills and Background:
The Greater Illinois Chapter Board of Directors has an ongoing commitment to improving the Board’s own leadership and management of its succession, renewal and recruitment of Board Directors. As part of the process surrounding seeking applications and recruiting new Directors to fill expired terms, candidates are asked to self-identify what competencies, background and skills the candidate would bring to the Chapter Board.

The Matrix of Skills and Representation below will ensure a skilled, balanced and high-performing Board is sustained for the future. Please use the following two checklists to personally rate your experiences level in each category, with 1 being low and 5 being a high level of experience, knowledge and appropriate representation.

* Checklist 1: Skills and Experience:
Low
High
Skill/Experience Competency 1 2 3 4 5
Board of Directors Experience Experience serving on public sector, private sector or not-for-profit boards. Experience with good governance policies
Business/Corporate Planning Experience Experience with business or corporate planning for public sector, private sector or not-for-profit boards.
Leadership Experience Experience serving as a Committee Chair or in other positions of leadership
Committee Experience and Teamwork Experience serving on committees or teams
Strategic Planning and Focus Experience with planning, evaluation, and implementation of a strategic plan. This includes a demonstrated ability to focus on longer term goals and strategic outcomes, as separate from day-to-day management and operational experience.
Government Relations and Public Policy Experience in strategic government relations and/or public policy agenda setting and effective communications for public sector, private sector or not-for-profit boards.
Human Resource/Executive Performance Review Understanding of human resource/personnel considerations and issues for employee recruitment, compensation structures, and performance review among public sector, private sector or not-for-profit boards.
Financial Reporting Understanding of financial reporting, and knowledge of other considerations and issues associated with the auditing requirements for public sector, private sector, or not-for-profit boards.
Investment Experience Experience in the investment industry including, managing investment portfolios, analyzing performance of outside investment managers, and developing investment strategies.
Risk Assessment Experience in the process of identifying principal corporate risks and to ensure that management has implemented the appropriate systems to manage risk.
* Checklist 2 – Balanced Representation:
Representative Category Competency
Personal experience with Alzheimer’s disease or a related dementia You, yourself, have been diagnosed by a qualified medical professional with Alzheimer’s disease or a related dementia
Yes No
Family experience with Alzheimer’s disease or a related dementia A close family member has experienced Alzheimer’s disease and you were, at least partially, responsible for the care of the family member
Yes No
Low
High
1 2 3 4 5
Professional experience with Alzheimer’s disease Engaged in a profession that regularly brings you in contact with individuals with Alzheimer’s disease or a related dementia
Legal Representation Experience as an attorney or in the legal profession
Communications Industry Representation Experience in marketing, communications, public relations, media or related industries
Accounting Representation Experience in accounting and financial professions
Medical Representation Experience as a licensed practitioner in the medical field
Public Policy Representation Experience in the political arena as an elected officials, lobbyist, policy director or related settings
Rural Service Delivery Representation Experience delivering medical and/or social service programs in rural areas
Other – please list below Describe competency of other representation below

Please tell us where you learned of the application process for the Greater Illinois Board of Directors. If you selected Association volunteer or staff, please supply the name and title of the person who made the referral.
The Chapter’s E-newsletter
The Chapter’s Magazine
The Chapter’s Website
Association Volunteer
Association Staff
Other (please describe)

Please list any other individuals, organizations or media where you learned about the application process.

I certify that the information I have provided is true and accurate to the best of my knowledge.
Date (mm/dd/yyyy format)
      • If selected by the Nominating Committee as a finalist, you will be notified, 1-2 letters of reference will be requested and your permission will be sought for background and reference checks prior to a personal interview. You will have an opportunity to print your completed application on the next page.

      Please mail your application to:
      Cindy Marsden, Office of the President
      Alzheimer’s Association
      8430 W Bryn Mawr, Suite 800, Chicago, IL 60631

      • Applications will not be considered unless all fields marked with an * and in red print are completed and you have signed the application.
      • You will receive confirmation when your application has been received.

        Thank You.



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