Are You a Resident of Kalamazoo County? YES NO
Have you had any Diversity, Equity & Inclusion Training? YES NO
Please indicate experience and/or qualifications that would help make you an effective board member for which you have applied:
Certain categories need to be represented on the Environmental Health Advisory Council. Please check categories which apply to you:
Please Note: A Recipient may be anyone who receives services on a regular basis from the Environmental Health Program of the Human Services Department.
Please indicate experience and/or qualifications that would help make you an effective member of the Environmental Health Advisory Council.
Why do you desire to serve on the Environmental Health Advisory Council?
State law prohibits an individual from being appointed to a community mental health board if he/she is a party to a contract with the community mental health services program or administers or benefits financially from such a contract; or (2) serves in a policy-making position with an agency under contract with the community mental health services program. Listed below is a list of agencies that contract with the Kalamazoo County Community Mental Health Authority Board. This list is not all-inclusive.
Do any of these restrictions apply to you? YES NO
Certain categories need to be represented on the Community Mental Health Authority Board. Please check the categories which you believe apply to you:
(defined as an individual who has received or is receiving services from the private sector equivalent to those offered by the Department or a community mental health services program)
(defined as an individual who is currently directly receiving mental health services from the Department of Community Mental Health, a community mental health services program, or a facility or from a provider that is under contract with the Department or a community mental health services program)
(defined as a parent, stepparent, spouse, sibling, child, or grandparent of a primary consumer, or and individual upon whom a primary consumer is dependent for at least 50% of his/her financial support)
If you checked category a, c, d, e or f above, please explain how you represent that category.
What personal or professional experiences have you had with the target populations served by the Community Mental Health Authority Board?
Why do you desire to serve on the Community Mental Health Authority Board?
There is a limit of six "public officials" who can serve on the Community Mental Health Authority Board. "Public officials" are those persons serving in an elected or appointed public office or employed more than 20 hours per week by an agency of federal, state, city or local government. This includes public schools/colleges/universities.
Are you a public official? YES NO
Certain categories need to be represented on the Older Adult Services Advisory Council. Please mark all categories which apply to you:
Please indicate experience and/or qualifications that would help make you an effective member of this council
Please indicate your experience for the following:
This committee has representation requirements. Please answer the following questions so your application can be reviewed under the appropriate sector(s):
Do you identify as a member of a high need and underserved neighborhood with disproportionately high instances of: (select all that apply)
Do you identify as a representative of an Advocacy Group* that supports members of groups experiencing historical and intersectional disparate impact, disproportionality, oppression and/or discrimination?
Do you identify as a person who is experiencing historical and intersectional disparate impact, disproportionality, oppression and/or discrimination?
Are you a public employee or elected official?
This committee requires a letter of recommendation from an Advocacy Group*. Attach your letter of recommendation when you submit your application.
*Advocacy Group is defined as a group of people who work to support an issue or protect and defend a group of people.
The Board of Commissioners desires minority representation on its appointed commissions. You may choose to identify yourself as a minority. Checking "yes" or "no" will neither qualify nor disqualify you for the appointment.
Representative of the minority community? YES NO
On what community board of directors/commissions are you a member?
Please indicate below the background experience you have which will be of value to you if you are appointed. Also indicate any reasons for desiring to serve on this Commission.
Part 115, Solid Waste Management, of the Natural Resources and Environmental Protection Act, 1994 PA 451, as amended, and the rules promulgated under the Act.
“Solid Waste Management Industry” as defined in R 299.4105(j). “Environmental Interest Group” as defined in R 299.4102(o). “Regional Solid Waste Planning Agency” as defined in Section 324.11505(2). “General Public” as defined in R 299.4103(e).
Please indicate experience and/or qualifications that would help make you an effective board member for which you have applied: (you may add your resume or curriculum vitae as an attachment)
Have you served honorably on active duty in the United States Armed Forces? YES NO
Do you have demonstrated knowledge, skills, and experience in the following areas: public service, business or finance? YES NO
Are you a member of a congressionally chartered veterans' organization within Kalamazoo County? YES NO
Do you wish to identify yourself as a member of a minority or underrepresented group? YES NO
Please attach a copy of your DD214 to this application -- applications will not be considered without this document. If you cannot upload a copy of your DD214, please fax a copy to 269-384-8032 or mail the copy to: Dina Sutton Kalamazoo County Board of Commissioners 201 West Kalamazoo Avenue Kalamazoo, Michigan 49007
