Thank you for your interest in becoming a CalMHSA Medi-Cal Peer Certification Stakeholder Advisory Council Member. CalMHSA is seeking applications to add additional Advisory Council Members to our committee. We are committed to continuing to elevate the Peer voice throughout the CalMHSA Peer Certification program. We appreciate you taking the time to complete this survey. Participation in the committee is voluntary and expect at least a 1-year commitment. The committee takes place monthly through a virtual platform for 1-hour duration. While CalMHSA is prioritizing adding new Advisor Council Member from the following regions: Bay Area, Los Angeles and Superior regions, we will review all applications received. CalMHSA will contact you on the status of your application once we have completed our review process.
We look forward to reviewing your application and appreciate you taking the time to complete this survey.

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* 1. What is your full name? 

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* 2. Please provide your email address

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* 3. What is your County of residence?

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* 4. What is your age group?

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* 5. What is your lived experience? (requirement)

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* 6. What is the area of lived experience you have? (requirement)

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* 7. Do you have personal lived experience with involvement in the justice system?

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* 8. Do you have lived experience (personal and/or Parent/Caregiver) in the following areas?

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* 9. Please provide a brief and comprehensive response to the following question.

Do you identify as a member of an underserved or underrepresented group (ethnic/cultural or marginalized)?

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* 10. Please provide a brief and comprehensive response to the following question.

What is your understanding of the Peer Support Movement in California?

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* 11. Please provide a brief and comprehensive response to the following question.

What is your objective and/or goal for participating as a council member of this group?

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* 12. Please provide a brief and comprehensive response to the following question.

If selected, what voice will you represent at the table?

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* 13. Please provide a brief and comprehensive response to the following question.

Do you have experience serving on local/regional/state committees or boards? Have you received any special recognition or acknowledgements for Peer support services?

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* 14. Please provide a brief and comprehensive response to the following question.

Have you provided paid or unpaid Peer Support Services? If so, how long?

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* 15. Please provide a brief and comprehensive response to the following question.

If selected, are you willing to agree to a 1-year commitment to the committee? (participate in committee meetings in a monthly basis)

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* 16. Please provide a brief and comprehensive response to the following question.

Please provide a brief description of how the Stakeholder Advisory council would benefit from your participation.

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