Apply for a Position on the Board

Thank you for your interest in becoming a board member for Dialysis Patient Citizens. Please fill out the form below to apply.

  • Having been selected by my peers to serve on the Board of Dialysis Patient Citizens (DPC), and being fully aware of the high honor bestowed upon me, I pledge to do my utmost to adhere to the following Code of Conduct.
  • I understand that membership on the Board is not a right I have earned, but a privilege bestowed by my colleagues to allow me to serve them and our mission.  I am the servant of DPC’s members, not their master.  I pledge to fulfill that role.
  • I understand that I have a fiduciary responsibility to the membership to oversee the finances of DPC.  I pledge that I will make myself aware of association non-profit accounting principles, read and understand the association’s financial reports, and obtain any information I need from the staff to fulfill this obligation.
  • I understand that funds contributed to DPC through individual and corporate donations are done so to further the mission and good works DPC, not to personally benefit members of the Board.  I understand that the expenditure of funds on luxuries for Board Members for travel, meals, accommodations, gifts and other special perks takes funding from the purposes which the donors intended, and that such misuse of funds is as serious as misappropriation of funds.  I pledge to be more frugal and responsible with the members’ money than I am with my own.
  • I understand that the most important principle of leadership is to set the example, and that the DPC staff and other volunteers will establish their own work ethic and fiscal responsibility based on what they see of my conduct.  I pledge to always be an example of dedication, probity and frugality for staff and other volunteers.
  • I understand that the true measure of a leader is one who knows and look out for the welfare of his or her followers.  I pledge to know and lookout for the welfare of DPC’s members and staff.
  • I understand there may be issues discussed at Board meetings that could damage individuals or the Association if discussed outside the Boardroom, and I pledge to maintain confidentiality of such items. But I also understand that the members are the owners of the Association and have a right to know how their association is operating.  I pledge to support operating in as open and transparent a manner as is possible, while keeping in mind that some issues must be kept confidential.
  • I understand that I have a responsibility to fully and fairly share my opinions at board meetings, but that I also have a responsibility to support Board decisions outside the Boardroom.  I pledge to do so.
  • I understand that to fulfill my fiduciary responsibility to the membership, I must be fully knowledgeable about the association.  I pledge that I will read and understand the bylaws, policies, financial reports, committee reports and other documents pertaining to the operations of DPC, and that I will devote the time necessary to stay current and to participate in Board meetings and conference calls.
  • I understand that I have a responsibility to apprise the Board any conflicts of interest that I may have, and to recuse myself from voting where a conflict exists. I pledge to avoid both the appearance and the actuality of any conflict of interest.
  • I understand that it is a violation of my fiduciary responsibility to the membership to appropriate to myself opportunities that rightfully belong to the association, or to usurp opportunities and appointments for myself that should be open to the membership.  I pledge not to do so.
  • I understand that my authority as a member of the Board is only in the Boardroom, and that I have no management authority or responsibility for the association outside of my participation in Board decisions. It is the staff’s responsibility to manage the association. It is the Board’s collective responsibility to set the strategic direction for DPC, to establish policies relating to ends, means and executive limits, to allocate resources and monitor financial performance, and to hire and oversee the chief staff executive. I understand that no one else can fulfill these Board responsibilities. I know this also means that I am strictly prohibited from approaching DPC staff for assistance with outside projects or to request preferential treatment for myself or any related party.  Any outside collaboration between me (or a related party) and DPC must be approved by the Board.  I pledge I will devote myself to helping the Board fulfill these strategic responsibilities.
  • I understand that perception is reality. I pledge to conduct myself in all things relating to the Association in such a manner that I would not be embarrassed to have my conduct fully reported as the lead story in the news.
  • I understand that members will look to me for their cues about DPC.  I pledge I will be an enthusiastic cheerleader and booster of DPC.
  • I understand that much of the success of DPC will depend on Board dynamics.  I pledge I will welcome diverse points of view, that I will feel free to disagree without being disagreeable, that I will not personalize disagreement, that I will discuss issues, not personalities and that I will avoid ad hominem attacks on board members, staff or other volunteers.
  • I understand that Board service is my opportunity to make a lasting contribution to DPC, our membership and dialysis patients as a whole.  I pledge I will work to leave DPC better, stronger and more fiscally sound that I found it at the start of my Board service.  I understand that if I am no longer able to fulfill my obligations as a DPC Board Member, it is my responsibility to submit my resignation effective immediately, so that a capable replacement can be found as soon as possible.
Resume/C.V.
In your resume or C.V. you should provide a detailed description of each of the following areas:
  • Educational background
  • (Kidney) community involvement
  • Volunteer experience
  • Honors, awards, achievements
  • Grassroots political action experience
  • Other political or government experience
  • Leadership, public speaking experience
  • Writing experience
Essay
In the space provided at the end of the application, please describe any involvement with DPC to date, including:
  • Meeting with legislators
  • Writing grassroots letters
  • Participating on DPC conference calls
  • Recruiting new DPC members
  • Distributing DPC materials/educational pieces
  • Fundraising
  • Anything else you would like to tell us about yourself

Board of Directors Application Form

Address(Required)
Are you a current dialysis patient?(Required)
Which of the following describes you?
Willing/able to travel by plane?(Required)
Willing to be away from home overnight (provided dialysis schedule is arranged as needed)?(Required)
Conflicts of Interest(Required)
DPC Board Members have a fiduciary duty to conduct their personal and professional affairs in such a manner as to avoid any possible conflicts of interest with their duties and obligations as Board Members. Board members and their immediate family members shall have no financial relationship with any dialysis providers, pharmaceutical manufacturers, or other related corporate entities in the renal industry other than a financial relationship established by reason of their being a patient. No Board Member or related party should derive any personal profit or gain, directly or indirectly, by reason of being a Board Member. In their capacity as Board members, they must subordinate personal, individual business, third-party, and other interests to the welfare and best interests of DPC. A conflict of interest may exist when a Board Member or related party has a financial interest in a decision by or on behalf of DPC; or where affiliations or other conflicts of loyalties of a Board Member or related party, involving any financial interest, may lead to, or appear to, suggest influence in a decision by or on behalf of DPC. No Board Member shall participate in any committee decision that could financially, professionally or materially benefit such Board Member or a related party. A related party is defined as a member of the immediate family of the Board Member, which includes his or her spouse, children and all other dependents, as well as estates, trusts and partnerships in which such Board Member or any such member of his or her immediate family has a present or vested future beneficial interest; a corporation or entity in which such Board Member or any such member of his or her immediate family is a beneficial owner of more than five percent of the voting interests; or any organization with which the Board Member is affiliated. Board Members are obligated to disclose to the DPC President any personal, financial or professional interest they, or any of their related parties, have in matters that come before the committees on which they serve.
Accepted file types: pdf, doc, docx, Max. file size: 200 MB.
Drop files here or
Accepted file types: pdf, doc, docx, Max. file size: 200 MB, Max. files: 3.