Civil Society Board Matching Program Please complete this form to register for the iiCanada Civil Society Database and to help us understand your current involvement in Agencies, Boards and Commissions, and/or your interest to participate in one. Please select your Region. * - Select -British ColumbiaEdmontonTorontoCity of TorontoNortheast OntarioPrairiesSouthwest OntarioQuebec and MaritimesYukon First Name * Last Name * Emal * Street Address (eg. #123 - 456 Main St.) City / Town * Province * - Select -British ColumbiaAlbertaSaskatchewanManitobaOntarioQuebecNova ScotiaNew BrunswichNewfoundlandPrince Edward IslandNorthwest TerritoriesYukonNunavut Postal Code Phone Number Your Age Under 20 years old 20 to 40 years old 40 to 60 years old Over 60 years old Highest Level of Education Diploma, Degree, Certifications, etc. Current Job Title Current Employer / Business Please Identify your Skill Sets (Select all that apply) Accounting Community Development Education Finance Fundraising Manufacturing Health Professional Information Technology Legal Management Marketing Organizational Planning Project Management Social Service Do you currently sit on any Agencies, Boards, or Commissions? * - Select -Yes - I currently sit on 1 boardYes - I currently sit on 2 boardsYes - I currently sit on 3 boardsYes - I currently sit on more than 3 boardsNo, I don't currently sit on any boardsAgency, Board, or Commission #1 Details Name of Agency Board or Commission #1 Current Position on Agency, Board, or Commission #1 Website of Agency, Board, or Commission #1 Term Start Date Agency, Board, or Commission #1 MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20192020202120222023202420252026202720282029 Year Term End Date Agency, Board, or Commission #1 MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20192020202120222023202420252026202720282029 Year Agency, Board, or Commission #2 Details Name of Agency Board or Commission #2 Current Position on Agency, Board, or Commission #2 Website of Agency, Board, or Commission #2 Term Start Date Agency, Board, or Commission #2 MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20192020202120222023202420252026202720282029 Year Term End Date Agency, Board, or Commission #2 MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20192020202120222023202420252026202720282029 Year Agency, Board, or Commission #3Â Details Name of Agency Board or Commission #3 Current Position on Agency, Board, or Commission #3 Website of Agency, Board, or Commission #3 Term Start Date Agency, Board, or Commission #3 MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20192020202120222023202420252026202720282029 Year Term End Date Agency, Board, or Commission #3 MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20192020202120222023202420252026202720282029 Year Please provide additional details on any other current or previous board experience. Please note that registration does not necessarily guarantee placement, as matching will depend on appropriate skills and fit. Thank you. Leave this field blank Submit
