County of Santa Clara
Behavioral Health Services Department
DRAFT FY 2021 Mid-Year Adjustment
Mental Health Services Act (MHSA)
30-Day Public Comment Period
October 17 - November 16, 2020
Stakeholder Comment Form

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* 1. What is your name?

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* 2. What is your organization or affiliation?

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* 3. What is your age?

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* 4. What is your gender?

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* 5. What group do you represent? Check all that apply.

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* 6. What is your ethnicity?

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* 7. What is your primary system transformation interest?

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* 8. Please provide your comments/feedback below.
Please be sure to clearly state the page number you are referring to for each individual comment you provide.

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* 9. If you prepared your comments in a separate file, please upload your file here.
Please be sure to clearly state the page number you are referring to for each individual comment you provide.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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Thank you for taking the time to provide your input.

Please visit www.sccbhsd.org/mhsa for information on the County’s MHSA
Programs and Services.

If you have any additional questions, please contact mhsa@hhs.sccgov.org or 408-401-6117.

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