CCIDC Board Member Application

CCIDC Board Member Application
Submit this form as well as your resume and a brief biography to apply to become a CCIDC Board Member. Qualified applicants will be required to attend a Board Orientation Webinar before the Selection Committee makes its final determination.
Name
Address
Professional Member | Area of Expertise or Public Member
Please list any Professional Organization/Club/Group you are affiliated with or a member of as well as your level of involvement (If None, type "None"). Please Provide: Organization Name | Affiliation/Membership Level | Involvement status
Drag & Drop Files, Choose Files to Upload
Drag & Drop Files, Choose Files to Upload
This information will be used for Board Member Bios on the CCIDC website
Drag & Drop Files, Choose Files to Upload
If selected, your headshot will be placed with your bio on the CCIDC website

Confidentiality Agreement Requirement for Board Members:

As the Board reviews and discusses sensitive matters, including employee-related issues, administrative concerns, and CID complaints, it is mandatory for all Board Members to sign the CCIDC Board Member Confidentiality Agreement.

Please review, sign, and submit the agreement via email to ccidcboard@ccidc.org prior to the Board Orientation.

By entering my name, I declare under penalty of perjury under the laws of the State of California that all information submitted is true, complete, and accurate. I acknowledge that false or incomplete information will result in immediate disqualification.
Date Application Signed/Submitted to CCIDC