Membership application request for the
Hôpital Montfort Association
General requirements:

Be at least 18 years old;

Be a resident of the province of Ontario for at least 3 consecutive months prior to date of membership

Has not been found mentally incompetent by a court of law, is not an undischarged bankrupt, and has not been disqualifie

The candidate, his or her partner nor his or her child is an employee of Hôpital Montfort.
Personal Information (You may attach your CV to this form)
Surname:
What is your mother tongue
*first language learned and still
understood
Given name:
French: ☐ English: ☐
Other: ☐
Oral expression and understanding
If your mother tongue is not
French, what is your level
of competency with
French?
Beginner ☐
Intermediate ☐
Written expression and understanding
Beginner ☐
Intermediate ☐
Advanced ☐
Advanced ☐
Address:
City:
Ontario
Province:
Telephone (home):
Postal code:
Work:
Male ☐ Female ☐
Email:
Current employment:
Availability
For which activity would you be interested in participating1?:
Board of Directors
☐
Development Projects Committee:
☐
Management Committee
☐
Auditing Committee
☐
Quality Council
☐
Teaching, Research and Innovation
Committee
☐
Governance Committee
☐
None
☐
Credentials Committee
☐
Volunteering
☐
Fundraising:
☐
Other types of engagement (please describe):
Motivation
Please share with us the reasons that motivate you to become a member of Hôpital Montfort’s Association
1
One is not obliged to be part of the Board of Trustees in order to be a member of a committee.
Areas of professional expertise
Please indicate your professional competencies
You may choose more than one.
Governance
Management
Clinical

Public organisation
☐

Human resources
☐

Medicine
☐

Private organisation
☐

Information technology
☐

Nursing
☐

Not-for-profit
organisation
☐

Risk management
☐

Project management
☐

Change management
☐
Financial Expertise

Auditing
☐

Finance
☐

Financial accounting
☐

Management
accounting

Financial institution
Business / Administration

Public (intergovernmental
relations)
☐
☐

Private
☐
☐

Communications

Marketing
Real estate development

Other healthcare
professional
Quality and safety
(evaluation and monitoring)
☐

Quality
☐

Security
☐
Teaching and research

Primary or secondary
teaching
☐
☐

College teaching
☐
☐

University teaching
☐

Research
☐

Engineering
☐

Architecture
☐

Law
☐

Construction
☐

Ethics
☐
Law and ethics
Military (present or past)
Other areas (please describe):
Declaration and signature
To become member of the Association, candidates must sign a declaration indicating that he/she:
 Has read and understood the specific characteristics and role of Hôpital Montfort as a Franco-Ontarian
institution as confirmed by the unanimous decision of the Court of Appeal for Ontario on December 7, 2001
(Lalonde v. Ontario (Health Services Restructuring Commission, 2001),56 O.R. (3d) 577
 Has read the objectives, the mission, vision and values of the Association, agrees to commit to respect
these and meet the expectations set out in this regard.
If I am elected member of the Hôpital Montfort Association, I agree to read and sign the declaration indicated above.
Name
Signature *
Date
*If you return the form electronically, your email will act in lieu of your signature.
You may return the form either by:

Email
pdg@montfort.on.ca

Fax
613-748-4963

Mail
713 Montréal Road, Ottawa, Ontario, K1K 0T2
Attn: President & Chief Executive Officer
☐
Summary of Commitment Levels
Committee Name
Terms of Reference
Board of
Directors
Govern and supervise the management of Association activities and business.
Executive
Committee
Exercise all powers of the Board of Directors in all urgent administrative
matters, report on all of its decisions at the subsequent Board of Directors’
meeting, and examine all business assigned to it by the Board of Directors.
Assist the Board of Directors in fulfilling its role in managing financial,
human and developmental resources to meet the hospital’s needs.
Management
Committee
Quality Assurance Support the Board of Directors in its quality assurance and patient safety role.
The Quality Assurance Board ensures that the quality of care and service is
Board
Governance
Committee
Development
Project
Committee
Education,
Research and
Innovation
Committee
Audit Committee
Credentials
Committee of the
Medical Advisory
Board
an integral part of hospital governance and management.
Assist the Board of Directors in fulfilling its role in selecting, guiding,
training and evaluating its members (who) and its role in evaluating its
operating methods (how) to ensure that the Board of Directors is able to fully
achieve its governance potential (what).
Assist the Board of Directors in meeting its responsibility to provide facilities
that meet Hospital needs and to supervise development projects.
Participate in developing and guiding education and research activities at
Hôpital Montfort.
Assist the Board of Directors in meeting its major responsibilities for
safeguarding the quality and integrity of financial information, internal
control and risk management procedures, as well as compliance with ethicsrelated legislation, regulations and standards.
Examine applications for appointments or appointment renewals among
professional staff and make recommendations to the Medical Advisory
Board.
Number of
Annual
Meetings
Average
Meeting
Length
10
2 hours
Upon request
(about 6)
2 hours
9
2 hours
10
2 hours
9
1.5 hours
10
(or more as
necessary)
1.5 hours
4
2 hours
6
3 hours
10
1 hour
Activity
*Review documents: requires
approximately 2 hours
*Review documents:
requires approx. 30 to 60
minutes
*Review documents:
requires approx. 30 to 60
minutes
*Review documents:
requires approx. 30 to 60
minutes
*Review documents:
requires approx. 30 to 60
minutes
*As necessary, member
participation in other
committee activities is required
*Review documents:
requires approx. 30 to 60
minutes
*Review documents:
requires approx. 30 to 60
minutes
*Review documents:
requires approx. 30 to 60
minutes
*As necessary, member
participation in other
committee activities is required
*Review documents:
requires approx. 30 to 60
minutes