VIRGINIA HIGHER EDUCATION SUSBTANCE USE ADVISORY COMMITTEE

INTEREST FORM

Thank you for your interest in the Virginia Higher Education Substance Use Advisory Committee (VHESUAC). Workgroup and Executive Council members are appointed by the Virginia ABC Board as spaces become available and serve on a voluntary basis. Please answer the following questions in order to be considered for appointment to either the Executive Council or Workgroup.

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* 1. Please indicate which level of VHESUAC you are interested in serving as a member on.

I would like to be considered for appointment to the Executive Council.

I would like to be considered for appointment to the Workgroup.

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* 2. How do you feel the Executive Council or Workgroup would benefit from your involvement as a member? Include any relevant experience, skills, interests, and/or motivations.

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* 3. Please provide your contact information.

First Name

Last Name

Institution/
Organization

Title

Email Address

Phone Number