BOARD MEMBERS WANTED
Inland Counties Regional Center, Inc. (IRC) is 1 of 21 regional
centers in California mandated through the Lanterman Act
to serve individuals with intellectual and developmental
disabilities.
IRC is currently seeking to fill two volunteer board member
positions. Applicants residing in San Bernardino County, of
Hispanic or Asian descent with business knowledge or past
board experience preferred. Board members must attend
regular monthly Board meetings, scheduled workshops/
trainings and participate in one Board Committee.
You may fill out the application below and submit via email. Applications accepted
until position is filled.
For additional information, contact Sandra Guzman at (909) 890-3402.
Inland Regional Center
P.O. Box 19037
San Bernardino, CA 92423
Reset Form
Board of Trustee Member Application
Name_________________________________________________________________________
Please check the BEST number above to reach you
□ Home Phone ______________________
□ Cell Phone ______________________
Home Address ________________________________City __________________Zip________
Best email Address______________________________________________________________
I reside in (check one)
□Riverside County
□ San Bernardino County
Ethnic Background (Optional) _____________________________________________________
Occupation ____________________________________________________________________
Hobbies and special interests:_____________________________________________________
______________________________________________________________________________
According to the Lanterman Act our Board must try to be equally represented by the area that
we serve and the clients of IRC. A minimum of 50 percent of the members of the Board shall be
persons with developmental disabilities or their parents or legal guardians. No less than 25
percent of the members of the Board shall be persons with developmental disabilities.
The Board shall include persons with legal, management, public relations, and developmental
disability program skills. These skills may be shown by persons who have a demonstrated
aptitude or experience in Human Resources, administrative, financial, and other executive level
positions. The Board shall include representatives of the various categories of disability served
by the Corporation. The Board shall reflect the geographic and ethnic characteristics of the area
served by the Corporation.
Please help us to be diverse and be sure you list any qualifying details.
Are you a: (Please check one)
□
□
□
Client of Inland Regional Center
Parent or Legal Guardian of a Client of Inland Regional Center
Representative of the general public
ICRC 15 (4/7/15)
If you are a client of IRC or a Parent/Legal Guardian of a client please indicate the type of disability
(e.g..,
intellectual
disability,
autism,
cerebral
palsy,
epilepsy,
other______________________________________________________
Have you ever served on a Board of a nonprofit? _____ What was the name of the nonprofit?
_________________________________________How many years did you serve? _____ were
you on the Executive committee? __________ if yes, what position or positions did you hold ?
__________________________
Have you had memberships in associations, service clubs, social clubs, or Professional
organizations? Please list all that may apply:__________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Are you a member of a governing board of any organization providing service to people with
developmental disabilities? □yes □no If yes please explain:
______________________________________________________________________________
How did you develop your interest in or knowledge of developmental disabilities? (Describe your
employment, education or other activities which demonstrate your interest or knowledge).
___________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Are you currently or (within the past 12 months) employed by any organization providing service
to and clients of the Inland Regional Center?
□ yes
□ no
If yes, please explain:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Our Board meets monthly, along with that evening meeting there is a commitment to serving on
2 committees and mandatory trainings. Board members are encouraged to attend events and at
times are asked to represent the IRC Board at various events along with a willingness to meet
with local legislators.
I am willing to serve and understand the commitment.
□ yes
□ no
Please fill out completely and hit send. You will be contacted soon.
Thank you for your interest.
ICRC 15 (4/7/15)
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