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BOD Membership Application

Thank you for your interest in joining our board! Please review the important information below before filling out and submitting an application. After your application is submitted, you may expect to hear from us within 1-3 business days to follow up!

Important steps in the application process: 

A nominee for the Community Child Guidance Clinic (CCGC) Board of Directors must be recommended by a current Board member or by the CCGC Executive Director.

1. The candidate should:

  • Become familiar with CCGC and it services by visiting our Programs and Services page.
  • Read the “Responsibilities of Board Members”.
  • Contact Dr. Jamie Bellenoit, Executive Director, for a tour of the clinic (860-643-2101).
  • Complete the online Application for Membership on the Board of Directors and attach a resume that includes at a minimum: education, employment history, and professional organization involvement.

2. The Board of Directors will vote on the candidate’s application at a regularly scheduled Board meeting as soon as possible.

3. After reviewing these steps, interested parties may also fill out the form below to complete their application.

Application for Membership on the Board of Directors
First Name
Last Name
Address Line 1
Postal Code
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