North Los Angeles County Regional Center

North Los Angeles County Regional Center

APPLICATION - BOARD OF TRUSTEES

Mailing Address:

North Los Angeles County Regional Center

Attention: Board Support

9200 Oakdale Avenue, Suite 100 Chatsworth, CA 91311 

Email Address: Boardsupport@nlacrc.org

Regional center boards are governed by extensive conflict of interest standards. To assure that you would not have any conflict of interest, it is necessary that you read, sign and return the enclosed Conflict of Interest Statement with your application.

The Bylaws of NLACRC require that persons serving on the Board of Trustees reside or work in the area served by this regional center (San Fernando, Santa Clarita, and Antelope Valleys

The board generally meets the second Wednesday of each month, at 6:00 p.m. The meetings are open to the public and we strongly recommend that you attend our meetings to better understand the trustee’s role. The board meeting schedule is included in your packet. Please note that all board meetings are currently being held via Zoom and may resume to in-person in the upcoming future, additional information will be provided.

Should you have any questions, please send us an email to Boardsupport@nlacrc.org. Thank you again for your interest in serving on our Board. We look forward to receiving the information requested!

Sincerely,

NLACRC Board Support 

Attachment(s): Board of Trustees Application and Conflict of Interest Form

 

Instructions: 

After you have completed this application and conflict of interest statement, please email your resume and a statement of interest to boardsupport@nlacrc.org.  

 

Supporting people with developmental disabilities in the San Fernando, Santa Clarita, and Antelope Valleys since 1974.

North Los Angeles County Regional Center

APPLICATION - BOARD OF TRUSTEES

I am a member of the following developmental disability, health, or other community organizations:

State of California–Health and Human Services Agency

DS 6016 (Rev. 08/2013)

CONFLICT OF INTEREST REPORTING STATEMENT

The duties and responsibilities of your position with the regional center require you to file this Conflict of Interest Reporting Statement. The purpose of this statement is to assist you, the regional center and the Department of Developmental Services (DDS) to identify any relationships, positions or circumstances involving you which may create a conflict of interest between your regional center duties and obligations, and any other financial interests and/or relationships that you may have. In order to be comprehensive, this reporting statement requires you to provide information with respect to your financial interests.

A “conflict of interest” generally exists if you have one or more personal, business, or financial interests, or relationships that would cause a reasonable person with knowledge of the relevant facts to question your impartiality with respect to your regional center duties. The specific circumstances and relationships which create a conflict of interest are set forth in the California Code of Regulations, title 17, sections 54500 through 54530. You should review these provisions to understand the specific financial interests and relationships that can create a conflict of interest.

Please answer the following questions to the best of your knowledge. If you find a question requires further explanation and/or there is not enough space to thoroughly answer the question, please attach as many additional sheets as necessary, and refer to the question number next to your answer. If the regional center identifies a conflict involving you, it will be required to prepare a conflict resolution plan. Some relevant definitions have been provided in the footnotes to assist you in responding to this statement.

You are required to file this Reporting Statement within 30 days of beginning your employment with the regional center or from the date that you are appointed to the regional center board or advisory committee board. You are then required to file an annual Reporting Statement by August 1st of every year while you remain employed with the regional center or while you are a member of the regional center board or advisory committee board. You must also file a Reporting Statement within 30 days of any change in your status that could result in a conflict of interest. Circumstances that can constitute a change in your status that can require you to file an updated Reporting Statement are described below in footnote one. 

*Change of status includes a previously unreported activity that should have been reported, change in the circumstance of a previously reported activity, change in financial interest, familial relationship, legal commitment, change in regional center position or duties, change in regional center, or change to outside position or duties. See California Code of Regulations, title 17, sections 54531(d) and 54532(d)

*Family member includes your spouse, domestic partner, parents, stepparents, grandparents, siblings, stepsiblings, children, stepchildren, grandchildren, parent-in-laws, brother-in-laws, sister-in-laws, son-in-laws and daughter- in-laws. See California Code of Regulations, title 17, sections 54505(f).

*For purposes of this question, hold a position generally means that you or a family member is a director, officer, owner, partner, employee, or shareholder of an entity or organization that is a regional center provider or contractor. For a specific description of positions that create a conflict of interest in a regional center provider or contractor see the California Code of Regulations, title 17, sections 54520 and 54526.

*Generally, a decision can financially benefit you or a family member if the decision can either directly or indirectly cause you or a family member to receive a financial gain or avoid a financial loss. For a specific description of the types of decisions that can result in a financial benefit to you or a family member see the California Code of Regulations, title 17, sections 54522 and 54527. 

*California Code of Regulations, title 17, sections 54523(b)(2) and 54528(b)(2) describes the types of conduct which constitute involvement in the making of a contract.

*For purposes of questions 8 and 9, a financial interest in a contract generally means any direct or indirect interest in a contract that can cause cause you or a family member to receive any sort of financial gain or avoid any sort of financial loss irrespective of the dollar amount. California Code of Regulations, title 17, sections 54523 and 54528 define when financial interests in a contract will occur.