Personal Information

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Employment Information

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Please answer the following questions

Why are you interested in becoming a member of the SHW Recipient Rights Advisory Committee (RRAC)?

I am/have been a primary consumer of mental health services (“Primary consumer means an individual who has received or is receiving service from the Department of Health and Human Services or a Community Mental Health services program or services from the private sector equivalent to those offered by the Department or CMH services program.)

I am/have been a family member of a primary consumer (“Family member means a parent, step-parent, spouse, sibling, child or grandparent of a primary consumer or an individual upon whom a primary consumer is dependent for at least 50% of his or her financial support.”)

Have you had previous involvement with the recipient rights system? If so, can you please describe your experience?

Have you had previous experience with county board related committees? If so, which committees have you participated on?

List memberships on any other mental health rights committees:

What talents, skills, or knowledge do you have that would contribute to the effective working of the committee?

The RRAC regularly meets the first Monday in March, December, and August at 5:30p.m. however, in the event of an appeal, can you be available to meet more often?

Yes

The RRAC is comprised of only six members and as such the committee may not select your application during the current vacancy. If you are not selected for committee participation at this time, may we keep your application on file for future use?

Yes

The RRAC regularly meets the first Monday in March, December, and August at 5:30 pm. These meetings are in-person meetings at 1555 Industrial Dr. Owosso, MI 48867. In the event of an appeal, can you be available to meet more often and in person?

Yes