BOARD APPLICATION COVER PAGE
San Andreas Regional Center Board of Directors is made up of volunteers from all areas of the community. Board members play an important role in providing policy leadership and oversight for our organization. Our Regional Center’s Board of Directors not only helps keep San Andreas connected to the community, but is responsive to its needs as well.
If you need help filling out the attached application or if you have questions about the application, please call the Administrative Assistant/Board Secretary at 408-341-3826. A resume may be included with completed applications but it is not a requirement. After you complete this form, please return it to the Regional Center by mail, fax, email, or in person (Please see below).
Conflict of Interest:
It is important that no conflict of interest exists between you as a potential board member and your other existing roles and responsibilities. The details of the above are contained in section 4626 of the Welfare and Institutions Code of the State of California. If you would like to request a copy of this section, please contact the Executive Administrative/Board Secretary (Please see below).
Required Information for the Centers for Medicare and Medicaid Services (CMS)
Should you be selected as a Board member you will need to submit: Full name, date of birth, complete social security number and home address. Failure to comply will make you ineligible to be a San Andreas Regional Center Board member.
Contact Information: Lourdes Gonzalez: Email at email@example.com , Telephone - 408-341-3826, Fax - 408-281-6967
San Andreas Regional Center
Attn: Board Development Committee
6203 San Ignacio Ave. Suite 200
San Jose, CA. 95119