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Thank you for your interest in the Councils of the Regional Commission on Homelessness. Please complete the following form to tell us your specific areas of interest and expertise and to help us determine the best fit for you.

Your information and expression of interest will be forwarded to the appropriate Council(s). You will hear from us soon regarding your participation and the orientation session that is required of all new Council members.

Please indicate your area(s) of interest by checking the appropriate box(es).
Addiction/Mental Health Council
Community Education Council
Employment Council
Prevention Services Council
Supportive Housing Council
Women and Children's Council

If you expressed interest in more than one Council, which would be your:
First choice:
Second choice:

Please describe the experience or expertise you would bring to those areas.
 
What would you hope to accomplish by your participation?
 
Are you:
service provider
advocate
concerned citizen
other

If "other", please specify:
 
Please share any other comments or questions you have regarding Councils.

Contact Information:
*First Name
*Last Name
Address Line 1
Address Line 2
City
State
Zip
Home Phone
Business Phone
Cell Phone
E-mail
Your preferred method of contact:
home work cell e-mail mail



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