Steering Committee Application

Please leave this field empty. Date

Name

Prefix

Sufix

Employer

Phone

Does this number receive text?
YesNo

Email

Mailing Address

Identify the sector(s) you most closely associate with (check all that apply)
Behavioral HealthBusinessEducationExperienced HomelessnessFinancial InstitutionFundingGovernmentHealthcareLegalNonprofitReal EstateSocial ServicesOther

Do you have 2-4 hours a month to dedicate to the committee’s work?
YesNo

List all current professional affiliations, boards, committees, and volunteer positions.

Why are you considering membership to the Steering Committee?

Describe the skills or expertise you bring to the Steering Committee. Be specific and elaborate.