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APPLICATION FOR APPOINTMENT
The Metropolitan Atlanta HIV Health Services Planning Council is federally funded and requires the following information about all applicants:

CERTAIN DEMOGRAPHIC INFORMATION.
- This information will not be used for any other purpose than for the selection of Planning Council members.

HIV STATUS OF APPLICANTS.
- You will be asked your HIV status during on this application. This information will not be used for any other purpose than for the selection of Planning Council members. You may decline to provide this information.

To the greatest extent possible, information provided on this form will be kept confidential; it will be viewed by the Planning Council staff and the Membership Committee. The Planning Council is required to submit information summarizing total numbers of Council members by race/ethnicity, gender, and HIV status.  

Please remember to notify our office of any changes in employment as this may affect your ability to serve on certain committees and could affect the conflict of interest status.

Please click NEXT below to continue with the application.

* 1. Consumer of Ryan White Part A Services

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