Board Candidate Interest Form

Thank you for expressing interest in serving as a Director on the Arizona Hospice & Palliative Care Organization (AHPCO) Board of Directors.  We greatly appreciate your willingness to share your time and expertise as a volunteer.  As a Director you will be responsible for the strategic direction and governance of the organization, including but not limited to:  fiscal responsibility, adherence to the bylaws (or proposing needed changes), member and sponsor recruitment and serving on a committee. 

 

The Board of Directors meets on the third Friday of every month (except July) beginning in January in the Greater Phoenix Metro Area.  Lunch is normally provided. For more information on specific responsibilities or the election process, please contact the Nominating Chair or the Executive Director in the AHPCO Office.  

 

Individuals that meet the requirements set forth in the bylaws will be considered by the Nomination Committee and if selected as a Nominee and approved by the Board will be placed on the ballot to be voted on by the membership during the Annual Election or Appointed by the Board to fill a vacancy.  Elected Directors must be either employees, owners or volunteers of a Provider Member.  

 

Election

The annual election of directors is held in the Fall.  Candidates are identified year-round via the Candidate Interest Form (below or click here for a printer-friendly form).  Candidate Interest forms received prior to August 1st will be considered by the Nominating Committee (provided the individual meets the requirements set forth in the bylaws) and if approved, the individual will be placed on the election ballot.  Forms received after August 1st will be considered for the next year's election or in cases of a vacancy, the individual may be considered by the board to complete the remainder of the year.  For more information on the election process, please contact either the current Nominating Chair or the Executive Director in the AHPCO Office.  

Basic Eligibility Requirements:

  • Affiliated with Provider Member* (Employee, Volunteer or Board Member)
  • Dues Paid Current
    *No more than one elected director may be affiliated with the same ownership entity.

Basic Expectations:  The board of directors is the governing body of the organization and has responsibility for the supervision, control and direction of the organization.  Directors are expected to:  

  • Serve a 3-year term (directors are eligible for a maximum of 2 consecutive terms).
  • Attend board meetings and at least 2 AHPCO conferences/events within a calendar year. 
  • Serve as a member of a Committe and assist at organizational programs and events as needed.
  • Participate in the Board's Strategic Planning process (including an Annual overnight Retreat)
  • Promote and represent quality hospice care for the community in cooperation with the membership.

  • Support and uphold the Mission Statement, bylaws, positions and decisions of the Board of Directors.

  • Be available by telephone/e-mail to assist all AHPCO members.

     

Form Instructions

Note:  only the individual desiring to be considered for a director may complete this form - it may not be completed for someone else and it is not considered a "nomination".  It is a non-confidential information gathering document.  The contents of the form will be reviewed by Staff and the Nominating Committee and if selected all or a potion of the contents of the form will be used and/or publicly displayed (for example:  the biography statement may be placed on the ballot).  Please do not divulge confidential information on the form.

 

You may find it easier to compose your responses in a word processing document (i.e. MS Word) first and then "cut & paste" your responses in the fields.  If you need assistance, please contact the AHPCO Office.

You may use the form below to indicate that you have an interest in being considered by the Nominating Committee for a seat on the Board of Directors - please review the expectations and guidelines prior to submitting this form to ensure that you meet the eligibility requirements and understand the commitment.  If you have questions or need assistance, please contact the AHPCO Office. 

First Name *

Last Name *

Email *
Phone *
Organization/Company *
Credential/Designations *

List in the order you wish them to appear after your last name (i.e. RN, CHPN)

 
1. Resume/CV *
2. Biographical Statement (150 words) *
3. Reason(s) you wish to serve as a Director (150 words) *

Service on the board as an elected director must be authorized by your agency by the appropriate person as designated in your agency's policies.  Please indicate the name and phone number of the person authorizing your candidacy.
4. Administrator/Supervisor Authorization *

 

In checking this box, you acknowledge that you believe you meet the eligibility requirements as outlined in the bylaws which include but are not limited to:

1) Elected director(s) shall be affiliated with a provider member of the Association.
2) No more than one elected director may be affiliated with the same ownership entity.
Eligibility *




Arizona Hospice and Palliative Care Organization | Advancing Quality Care for Arizonans | (480) 491-0540