Kaweah Health Community Advisory Committee Application

Kaweah Health Community Advisory Committee Application
Kaweah Health Community Advisory Committees work to identify opportunities to enhance local partnerships and community relations, to provide ideas about future community health needs to reflect and cater to the needs of our diverse region, and to plan for future buildings and facilities.
Name*
I am over the age of 18

Yes
Home Address
Home Phone*
Format: (000) 000-0000.
Cell Phone*
Format: (000) 000-0000.
Email*
example@example.com
Profession:
Employer:
Language(s) Spoken
Please tell us why you are interested in joining a Kaweah Health Community Advisory Committee and what specific skills you bring to the process.
What is your goal in serving on a committee, and what do you expect to accomplish?
Please describe any other committee experience you may have had either in school, community, churches, etc. (Note: prior committee experience is not required)
Please describe any other committee experience you may have had either in school, community, churches, etc. (Note: prior committee experience is not required)
Please tell us the committee you are interested in serving on

Community RelationsHealthcare for Today and TomorrowEmergency Department Advisory CommitteeCommunity AmbassadorOther
Please tell us the easiest time for you to attend meetings:

DaytimeEvening
Signature
Date

MonthDayYear
Date
Questions, please contact Deborah Volosin via email at dvolosin@kaweahhealth.org
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