Community Advisory Committee Volunteer Application

Paperflower Foundation

Community Advisory Committee
Equity is Intentional
Paperflower Foundation provides financial assistance for therapy, psychiatric evaluations, medication management, and prescriptions to Arizonans facing financial or insurance barriers to care.

Our Community Advisory Committeee ensures that our programs are shaped by the people we serve. Lived experience is the qualification — no professional background is required.

Fields marked with * are required.
1. PERSONAL INFORMATION
First Name *Last Name *
PrefixPreferred NamePronounsDate of Birth (MM/DD/YYYY)
Phone Number *Email Address * Mailing Address (City, State, ZIP)
County / Region in Arizona *Preferred Language
2. BACKGROUND & COMMUNITY CONNECTION
Person with lived experienceFamily member / caregiverMental health advocateCommunity member / neighborOther
BIPOCLGBTQ+Rural / frontier ArizonaUninsured / underinsuredNeurodivergentVeteran / military-connectedYouth / young adult (18-25)Older adult (65+)Other
What is your connection to mental health care access barriers? Share as much or as little as you are comfortable with.*
InstagramWebsiteReferral from someone I knowFacebookEmail / newsletterOther
3. LIVED EXPERIENCE
Please describe your personal experience navigating the mental health care system. What barriers have you or someone you care for faced?*
You may share your own story or that of someone you've supported.
What do you believe are the most significant gaps in mental health care access in Arizona?*
Is there a specific population or issue area you feel especially passionate about representing?*
4. SKILLS & CONTRIBUTIONS
What skills, perspectives, or strengths would you bring to this committee?*
Is there anything else you would like for us to know about you or why you want to join the Community Advisory Committee?
5. AVAILABILITY & LOGISTICS

The Community Advisory Committee meets biannually (2 times per year) virtually.
Weekday morningsWeekday afternoonsWeekday eveningsWeekend morningsWeekend afternoonsFlexible
6. REFERENCES
Please provide one personal or community reference (not a family member). References will only be contacted if your application moves forward.*

Reference NameRelationship to You
Reference Phone Reference Email
7. ACKNOWLEDGMENT & SIGNATURE

By signing below, I confirm that the information provided in this application is accurate and complete. I understand that the Community Advisory Committee membership is a volunteer role, that meetings occur twice a year, and that my participation may be featured in foundation materials only with my explicit consent. I also understand that I may withdraw from the committee at any time.
Signature*
Date*

MonthDayYear
Date
Printed Name*
Questions? Visit paperflowerfoundation.org
or call/text 855-210-7731

Paperflower Foundation · Community Advisory Committee · info@paperflowerfoundation.org
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Paperflower Foundation

Equity is Intentional

1. PERSONAL INFORMATION

2. BACKGROUND & COMMUNITY CONNECTION

3. LIVED EXPERIENCE

4. SKILLS & CONTRIBUTIONS

5. AVAILABILITY & LOGISTICS

6. REFERENCES

7. ACKNOWLEDGMENT & SIGNATURE