Home / About / Board of Directors / Board of Directors ApplicationBoard of Directors Application History of the Clinic Board of Directors Join Our Board Executive Team Join Our Board Fill out the form below or download the application pdf. All fields marked with an asterisk (*) are required. Download Application Name* First Last Home Address* Street Address Address Line 2 City State Zip Phone*Email* How many years have you resided in our community?* Do you have a relative(s) that are currently employed with Waterfall Community Health Center? If so, list name(s).Click the plus (+) sign at the end of the row to add another input field. Please list any prior experience working with non-profits or on a board of directors.*What strengths, skills, and/or education do you have that will help you in your role as a member of the Board?*Why do you want to serve as a member of the Waterfall Board of Directors?*Any other feedback or comments to include in this application?ReferencesAdd your references*Click the plus (+) sign at the end of the row to add another reference.NameAddressOccupationPhoneEmail Certification of ApplicationBy submitting this application form I hereby certify that the above information is true and correct. I also authorize the Waterfall Community Health Center Board, or the designee of the Board to verify information contained in this application.