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Click ‘Get Form’ to open the hrsa form 6a fillable in the editor.
Begin by entering the names of current board members in the designated fields. Ensure accuracy as this information is crucial for your application.
For each board member, specify their current office position held, gender, and area of expertise. This helps in assessing the diversity and qualifications of your board.
Indicate whether any board member earns more than 10% of their income from the health industry by selecting 'Yes' or 'No'.
Mark if any board member is a health center patient and if they live or work in the service area. This information is vital for compliance.
If applicable, specify if any board member represents a special population and provide details as required.
Complete the patient board member classification section by indicating the number of male, female, and unreported/declined to report members.
Finally, answer whether the listed board members represent a co-applicant board if your organization is public. Attach necessary agreements as specified.

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Versions	Form popularity	Fillable & printable
2019	4.7 Satisfied (36 Votes)
2016	3.9 Satisfied (37 Votes)

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