Health Equity Advisory Committee Application

Application for Membership

The deadline to be considered for the 2019-2021 cohort of the HEAC ended on July 8, 2019. If you would like to be considered for a future position on the committee, submit your application here. Applications will be considered as positions become available.

If you have questions or need application assistance, please contact Jannet Sanchez, Healthy Equity Coordinator, at 617-534-2376 or by email at jsanchez@bphc.org

For more information, please visit our webpage.

Purpose
The Health Equity Advisory Committee (HEAC) advises BPHC in its work to advance racial justice and health equity for all Boston residents. The HEAC participates in the planning, development and implementation of BPHC’s Strategic Plan’s Racial Justice and Health Equity priority areas including policy matters, communications, and equitable and inclusive community engagement practices.

Membership
The HEAC needs people like you! Members are residents, clients of BPHC’s services, and stakeholders that represent Boston’s ethnically and culturally diverse viewpoints and interests. Emphasis is placed on ensuring the membership reflects the socio-demographic groups impacted by health inequities.

Membership Responsibilities

Serve a two (2) year membership term and attend no more than ten (10) meetings a year.
Represent the concerns and interests of their communities and/or their respective constituency by actively participating in meeting discussions.
Ensure BPHC’s work is responsive to community needs and aligns with BPHC’s mission, vision, and the Strategic Plan’s Racial Justice and Health Equity priority area.
Review population health data reports, health planning documents, and other materials to make recommendations on BPHC policies, procedures, programs and services.
Promote community awareness of the social determinants of health and health equity issues.
Collaborate with BPHC’s programs and services to plan, support, and facilitate community meetings and special events.
Attend, as needed, other internal and external partner meetings.

Membership Benefits

Members serving as a neighborhood resident or as a client of BPHC services will receive a participation stipend of $50.00 for attending HEAC and other community meetings or events.
Free leadership development and educational trainings to enhance personal and professional skills.
Opportunities to ensure that community perspectives and guidance are considered in policy and program design

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* 1. Contact Information

Name *

Address

Boston Neighborhood

ZIP Code *

Email Address *

Phone Number *

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* 2. Please select the best way to reach you

Mail

Phone

Questions 3-10: Please check the box for each category with which you most closely identify. Supplying this information will assist BPHC to achieve diversity on its HEAC. Your response will be kept CONFIDENTIAL and available only to BPHC support staff.

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* 3. I identify as

Man

Woman

Genderqueer/Non-binary

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* 4. I identify as transgender

Yes

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* 5. I identify as LGBTQ

Yes

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* 6. I am a veteran

Yes

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* 7. My age range is

18-24

25-34

35-44

45-54

55-64

65+

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* 8. Hispanic or Latinx: I am

Hispanic or Latinx

Not Hispanic or Latinx

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* 9. Federal Race Category: I am

American Indian/Alaska Native

Asian

Black or African-American

Native Hawaiian/Pacific Islander

White

Other

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* 10. Ethnic Groups: I am

Arab/Middle Eastern

Afro-Caribbean

Cape Verdean

Chinese

Colombian

Dominican

Haitian

Portuguese

Puerto Rican

Vietnamese

Don't Know

Other (please specify)

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* 11. If selected as a member of the HEAC, please indicate the category you wish to represent most appropriately. I am a...

Client of BPHC’s programming or services (list program below)

Community resident (list neighborhood you live in below)

Provider of public service (list agency below)

Employee of a local advocacy or organizing group (list group below)

Other (please specify below)

Please specify

Questions 12 - 15: If you need more space than provided, feel free to continue on a separate document and upload it on Question 17.

Responses to questions 12-15 are REQUIRED. Incomplete applications will not be considered.

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* 12. Please explain why you want to become a member of the Health Equity Advisory Committee.

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* 13. What qualities, skills, or experiences do you hope to contribute to the Health Equity Advisory Committee and its work?

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* 14. What is your current involvement in your community? Please describe your participation or relationship in any community-based organizations and/or local organizing group work.

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* 15. What experiences (personal or formal training) have you had in public health and/or social or racial justice?

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* 16. How did you hear about the opportunity to become a HEAC member?

BPHC Newsletter

BPHC Social Media

Newspaper

Community Event

Community Organization

Other (please specify)

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* 17. You may attach a resume or other supporting documents that you have written that reflect your community work.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 18. Please list one reference who can speak about your skills or experiences.

If you cannot provide one at this time, a reference may be asked from you at a later time. Please have that information ready.

Name of Reference

Organization Affiliation

Email Address

Phone Number

Health Equity Advisory Committee Application

Application for Membership

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* 1. Contact Information

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* 2. Please select the best way to reach you

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* 3. I identify as

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* 4. I identify as transgender

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* 5. I identify as LGBTQ

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* 6. I am a veteran

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* 7. My age range is

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* 8. Hispanic or Latinx: I am

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* 9. Federal Race Category: I am

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* 10. Ethnic Groups: I am

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* 11. If selected as a member of the HEAC, please indicate the category you wish to represent most appropriately. I am a...

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* 12. Please explain why you want to become a member of the Health Equity Advisory Committee.

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* 13. ﻿What qualities, skills, or experiences do you hope to contribute to the Health Equity Advisory Committee and its work?

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* 14. What is your current involvement in your community? Please describe your participation or relationship in any community-based organizations and/or local organizing group work.

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* 15. What experiences (personal or formal training) have you had in public health and/or social or racial justice?

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* 16. How did you hear about the opportunity to become a HEAC member?

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* 17. You may attach a resume or other supporting documents that you have written that reflect your community work.

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* 18. Please list one reference who can speak about your skills or experiences. If you cannot provide one at this time, a reference may be asked from you at a later time. Please have that information ready.

* 13. What qualities, skills, or experiences do you hope to contribute to the Health Equity Advisory Committee and its work?

* 18. Please list one reference who can speak about your skills or experiences.

If you cannot provide one at this time, a reference may be asked from you at a later time. Please have that information ready.