Part I - Nominee Contact Information
Part II - Background Information
Complete to the best of your knowledge. You are also welcome to submit a resume.
(PDF, doc, docx only)
(If space does not permit, please attach additional document below)
3. Current or past employment
4. Membership in Professional Organizations (List)
5. Designation, awards or other recognition (List)
Part III - Award Selection Criteria
Please provide a comprehensive description of your nominees qualifications against the following selection criteria, as more fully described above:
- Leadership and Stewardship
- Accountability to Stakeholders
- Contributions to Governance
- Relationship with the CEO and Management
- Enhancing the Effectiveness of the Board
Please cite examples that demonstrate actions/initiatives that go above and beyond what is normally expected in the boardroom. Note: Please do not exceed 1000 words.
Part IV - References
Part V - Nominator Contact Information
To the best of my knowledge, the information contained in this application is true and
(enter full name of Nominee) adheres to the principles outlined in the ICD Code of Conduct (excluding those sections that refer to ICD membership).