Application for Community Advisory Committee

Application Information for CPAA Consumer Advisory Committee

To apply please give us some information about yourself in the questions that follow. Once you have filled out your application we will contact you shortly to discuss next steps. If you have not heard from us, feel free to call or email at the information below.

If you have any questions please email or call at: moorem@crhn.org or (360) 539-7576 ext 101.

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* 1. First and Last Name:

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* 2. Email Address:

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* 3. Phone Number:

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* 4. County of Residence:

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* 5. Age (must be at least 18 years old to participate):

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* 6. Are you of Hispanic, Latino, or Spanish origin?

Yes

Unsure

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* 7. How would you describe yourself?

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White or Caucasian

Application for Community Advisory Committee

Application Information for CPAA Consumer Advisory Committee

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* 1. First and Last Name:

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* 2. Email Address:

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* 3. Phone Number:

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* 4. County of Residence:

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* 5. Age (must be at least 18 years old to participate):

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* 6. Are you of Hispanic, Latino, or Spanish origin?

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* 7. How would you describe yourself?

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* 8. Have you ever been part of an Advisory Board or any similar group? (please describe any experience you have in this area).

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* 9. Is there anything else you would like to let us know about yourself (please write it here)?