New Member Interest Form

Miami-Dade HIV/AIDS Partnership New Member Interest Form

Get on Board!

Thank you for your interest in volunteering for the Partnership - the official Miami-Dade County Advisory Board for HIV prevention and care.

Our members are appointed by the Mayor of Miami-Dade County to make decisions that improve the lives of more than 8,000 people served by the Ryan White Program in Miami-Dade County.

Your participation matters! Let's get started!

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* 1. Please complete this contact Information.

Your name *

Name of city where you live *

ZIP Code of city where you live *

Your email

Your phone number *

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* 2. What is the best way to contact you? (check all that apply)

Phone Call

Text Message

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* 3. Are you a permanent resident in Miami-Dade County?

Yes

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* 4. Are you a registered voter in Miami-Dade County?

Yes

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* 5. Can you devote up to five (5) hours each month as a volunteer board member?

Yes

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* 6. Please provide a brief statement explaining your interest in the Partnership and the HIV planning process, including your background relative to HIV (volunteer, professional, personal) and/or other relevant experience and expertise.

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* 7. Great! We're almost done! Please check all statements that apply to you.

I am a Ryan White Program client.

I am a Ryan White Program client working for a Ryan White Program provider organization.

I am a representative of HIV positive incarcerated persons.

I am a non-elected community leader. I do not provide HIV health care services subject to Ryan White Program funding.

I am a housing, homeless, or social services representative.

I am a substance use recovery or mental health services representative.

I am a prevention services representative.

I am a health care provider representing a Federally Qualified Healthcare Center.

I am a hospital or health care planning agency representative.

I am a community-based AIDS service organization representative.

I am a Miami-Dade County Public Schools representative.

I am a state government/Medicaid agency representative.

I am a Florida Department of Health in Miami-Dade County representative.

I am a State of Florida General Revenue grantee representative.

I am a representative of a federally funded HIV grant (HOPWA, Ryan White Part F (SPNS), CDC, SAMHSA)

I am a Ryan White Program Part A grantee representative.

I am a Ryan White Program Part B grantee representative.

I am a Ryan White Program Part C-funded provider representative.

I am a Ryan White Program Part D-funded provider representative.

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* 8. Next Steps

We will contact you to answer questions about membership, schedule a preliminary interview (via Zoom), and schedule an interview with the Community Coalition Roundtable. The Roundtable meets monthly; here are future meeting dates:

June 26, 2023

July 31, 2023

August 28, 2023

September 25, 2023

October 30, 2023

November 27, 2023

All meetings are 5:30 p.m. - 7:30 p.m. and include dinner. Click here for details on meeting locations.

Please click DONE to submit your application.

Thank you!