Opioid Restitution Fund Commission
Student representative interest form

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1. Please indicate which of the following apply (Required.)

I am interested in serving on the Opioid Restitution Fund Commission.

I may be interested in serving on the Opioid Restitution Fund Commission, but would like to learn more.

Other (please specify)

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2. Are you a resident of Howard County, Maryland? (Including college students whose permanent address is in Howard County) (Required.)

Yes

No

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3. What is your age? (Required.)

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4. Why are you interested in the Opioid Restitution Fund Commission?

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5. What is your email address? (Required.)