Board of Governors Application Section 1: Applicant InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone*Email* Section 2: Knowledge, Skills, and Experience Self-Assessment The Board seeks a complementary balance of knowledge, skills, and experience. Please indicate your depth of knowledge, skills, and experience by selecting the appropriate column to indicate your skill level. It is not expected that you will have experience in all the areas.Advancement/Fundraising Basic Intermediate Advanced Advocacy Basic Intermediate Advanced Capital Planning Basic Intermediate Advanced Change Management Basic Intermediate Advanced Data Analytics Basic Intermediate Advanced Digital Literacy Basic Intermediate Advanced Diversity & Inclusion Basic Intermediate Advanced Finance/Investment/Accounting Basic Intermediate Advanced Governance Basic Intermediate Advanced Government/Political Knowledge Basic Intermediate Advanced Human Resources/Labour Relations Basic Intermediate Advanced Indigenous/Aboriginal History/Community Basic Intermediate Advanced Policy Development Basic Intermediate Advanced Public Relations/Stakeholder Relations Basic Intermediate Advanced Regulatory/Legal Basic Intermediate Advanced Risk Management Basic Intermediate Advanced Strategic Planning Basic Intermediate Advanced Section 3: Submit resume and cover letter File upload* Drop files here or Select files Accepted file types: pdf, doc, docx, Max. file size: 49 MB. Section 4: Declaration By submitting the application, I declare the following: The information in this application and in my resume is accurate and true; I am at least 18 years of age; I have not been found under the Substitute Decisions Act, 1992 or under the Mental Health Act to be incapable of managing property; I do not have the status of an undischarged bankrupt; I have not been convicted of a criminal offense; I am not an employee or a student of any college of applied arts and technology; I have read and agree to be bound by Durham College By-law No. 1; I have read and agree to be bound by the Board policies on Governors’ Duties and Responsibilities and Governor Code of Conduct; I am willing to serve as, and fulfill the duties of a governor with no remuneration. By submitting this form, I agree with the declaration above and I am giving Durham College permission to connect me at the telephone number and/or email address provided.* I agree Date* MM slash DD slash YYYY CAPTCHAEmailThis field is for validation purposes and should be left unchanged. Notice of Collection: In accordance with Section 39(2) of the Freedom of Information and Protection of Privacy Act, 1990, the personal information collected on this form is collected under the legal authority of the Ontario Colleges of Applied Arts and Technology Act, 2002 and may be used and/or disclosed for the purpose of reviewing your application to the Board of Governors. If you have any questions about the collection, use and disclosure of your personal information by the College, please contact the Freedom of Information and Protection of Privacy Coordinator, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, 905.721.2000 ext. 3292.