Applications

Board Member Candidate Review Form

The Board of Directors needs you!

ARE YOU INTERESTED IN BEING PART OF OUR LEADERSHIP?

THE BOARD OF DIRECTORS ENSURES WE CARRY OUT OUR MISSION.

IF YOU WOULD LIKE TO VOLUNTEER FOR OUR BOARD PLEASE ASK FOR AN APPLICATION

(Front desk/medical receptionist will have them available)

MISSION

G. A. Carmichael Family Health Center?s mission is to provide access to quality affordable primary healthcare with compassion and professionalism in the communities we serve. NOTE: Access is cornerstone of HRSA/Bureau of Primary Health Care and NACHC

Click here to view Board Applicants Expectations.

After filling the details click on the SUBMIT button.

Applicant Name:

Address:

Home Phone:

Work Phone:

Email Address:

What is the best place/time to reach you?:

Are you a patient of G. A. Carmicahel FHC?:

Yes
No

If so how Long?:

Other Family Member Patients at the Clinic?:

Yes
No

Adults:

Children:

Are you a health care provider?:

Yes
No

Reasons to become a GACFHC Board Member:

Please use this section to tell us more about you.:

Which committee would you be interested in?:

Governance (By-Laws)
Finance
Quality Assurance
Planning and Development

Please check below:

To my knowledge, I am not related to any member of the staff by blood or marriage.
I have the time available to attend monthly board meetings.

Applicant Signature (Please type name here):

Date of Application:

After completing the questions click on the SUBMIT button.

G. A. Carmichael Family Health Center "Put Your Family's Health In Our Hands"