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APPLICATION FOR APPOINTMENT
TO THE HOUSTON RYAN WHITE PLANNING COUNCIL
The Ryan White 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 the application interview. 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.

PLEASE NOTE THAT PLANNING COUNCIL APPLICATIONS ARE CONSIDERED PUBLIC DOCUMENTS AND CAN BE VIEWED BY MEMBERS OF THE PUBLIC UPON REQUEST. THEREFORE, IT IS IMPORTANT THAT YOU DO NOT GIVE YOUR HIV STATUS OR OTHER PERSONAL HEALTH INFORMATION ON THIS FORM IF YOU DO NOT WISH FOR THE INFORMATION TO BE PUBLIC.



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