The Pulse Community Advisory Committee Application

Thank you for your interest in supporting The Pulse School-Based Health Center and joining the Advisory Committee. This committee is currently scheduled to meet twice annually. Advisory Committee members will provide feedback and support to The Pulse Steering Committee comprised of members from the shared leadership teams of Valley-Wide Health Systems and Solvista Health in partnership with the Canon City School District. The Community Advisory Committee serves in an advisory capacity only; operational decisions are made by the partner organizations. Applications are due by April 15th and the Advisory Committee term will start May 1st.

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* 1. What is your first and last name?

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* 2. What is your phone number?

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* 3. What is your email address?

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* 4. What is your mailing address?

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* 5. Do you live within the Canon City RE-1 School District? This is a requirement to serve on The Pulse Advisory Committee

Yes

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* 6. Are you able to commit to serving for a minimum term of 1 year? Advisory Committee members will be asked to attend two meetings during each calendar year and attend a brief orientation regarding School-Based Health Centers.

Yes

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* 7. Do you have school age children enrolled in a Canon City RE-1 School? This is NOT a requirement to serve on the Committee.

Yes

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* 8. Why are you interested in joining the Advisory Committe?

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* 9. What unique perspective and/or experience would you bring to the Advisory Committee?

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* 10. Please share any additional information you think would be helpful as we consider your application.