Alliance Health Consumer and Family Advisory Committee (CFAC) Application

Alliance Health Consumer and Family Advisory Committee (CFAC) Application
Alliance CFAC promotes a community-based support system that seeks to have each person reach his or her full potential. This committee of individuals and family members gives voice to the interests and opinions of persons with needs related to mental health, intellectual and developmental disabilities, traumatic brain injury, and substance use. It embraces the dignity of all residents in our communities so that each person may achieve his or her highest level of responsibility in the community. It promotes the empowerment of individuals and the active involvement of family members.

Adult individuals are qualified to be advisory members of the committee if they or a member of their family is a consumer of mental health, intellectual and developmental disabilities, substance use disorder, or traumatic brain injury services.
Full name
Phone
Address

Street Address

Street Address Line 2

CityState

Zip Code
County
Email
example@example.com
Date (mm/dd/yyyy)

MonthDayYear
Date
What disability/disabilities do you represent?

Mental HealthSubstance UseIntellectual/DevelopmentalTraumatic Brain Injury
Are you a person with lived experience or a family member?

A Person with Lived ExperienceA Family Member
Briefly explain why you are interested in participating on the Alliance Health CFAC:
Should be Empty: