Opioid Restitution Fund Commission
Student representative interest form

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* 1. Please indicate which of the following apply

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)

Yes

No

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* 3. What is your age?

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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?