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Application For Advisory Committee Membership - Texas Health And Human Services Commission

Texas Health and Human Services Commission

Application for Advisory Committee Membership

The Behavioral Health Advisory Committee is seeking applications from youth/young adult

consumers of mental health and/or substance use disorder services and/or behavioral health

advocates or representatives of behavioral health advocacy organizations. If you wish to apply

to be a member of the Behavioral Health Advisory Committee, please fill out this application.

The Behavioral Health Advisory Committee will advise the Health and Human Services

Commission (HHSC) on allocation and adequacy of behavioral health services and programs

within the State of Texas.

If a question does not apply to you, enter “N/A.”

Please attach a resumé.

HHSC will use the information you put on this application and your resumé to decide if you are

eligible to serve on this committee.

Important note: Committee members who are adult consumers of mental health and/or substance

use disorder services, youth/young adult consumer of mental health and/or substance use

disorder services; and family representatives of consumers of mental health and/or substance

use disorder services may be reimbursed for their travel to and from meetings if funds are

available. Other members are responsible for their own expenses.

HHSC will not consider an application received or postmarked after December 31, 2016.

SECTION 1 - Personal Information

Name:

Home Address:

City:

State: TX

Zip:

Phone:

Fax:

Email:

Employment Information

Business/Organization:

Address: