Trillium Board of Directors Application Form

Thank you for your interest in joining the Trillium Community Health Plan Board of Directors. Our mission is transforming the health of the communities we serve, one person at a time.

This application will be used to identify and evaluate potential board candidates. Each board member term is two years, with a time commitment of 2-4 hours per month in attendance at Board and Committee meetings. The board provides guidance and recommendations to Trillium on strategy to ensure effectiveness to achieve its objectives. Trillium seeks representatives from independent and diverse perspectives.

Name *

Mobile number *

Work number

Personal email

Work email *

Employer Name

Your Title *

Employer Address *

Customers Served *

Address Line 2

City *

State *

Zip Code *

Customers Served *

Your current organizational affiliations (names of the organization and your role) *

Briefly describe why you would like to join the Trillium Community Health Plan Board of Directors *

What are your areas of interest, special skills, Committee interest (i.e. Social Determinants of Health, Housing, Nutrition, Health Equity, Quality Improvement, Medical Management, Finance, etc.). *

Attach CV/Resume *