Partner Advisory Board Application
Paperflower Foundation
Thank you for your interest in joining the Paperflower Foundation Partner Advisory Board. We review applications on a rolling basis and will follow up within three weeks.
Fields marked with * are required.
SECTION 1 — CONTACT INFORMATION
Full Name:
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Preferred Name (if different:)
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Pronouns (optional):
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Email Address:
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Phone Number:
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City / State:
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LinkedIn or Website (optional):
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SECTION 2 — PRACTICE / ORGANIZATION INFORMATION
Practice or Organization Name:
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Your Title / Role:
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Are you an owner of this practice or facility?
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Yes, sole owner
Yes, co-owner or partner
No, I am an employee or administrator
Practice Type (select all that apply):
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Solo mental health practice
Group mental health practice
Psychiatry practice
Intensive Outpatient Program (IOP)
Urgent care with mental health services
Mental health facility
Other:
If you answered 'other' to 'Practice Type (select all that apply):', please specify below.
SECTION 3 — CLINICAL BACKGROUND
What license(s) or credentials do you hold?
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What mental health conditions or challenges does your practice most commonly address?
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SECTION 4 — CONNECTION TO OUR MISSION
How did you first learn about Paperflower Foundation?
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Why are you interested in joining the Partner Advisory Board?
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What unique perspective or expertise would you bring to the Partner Advisory Board?
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Paperflower Foundation believes that systemic and social factors, including race, income, housing, and access, significantly shape mental health outcomes. How does that perspective align with your own, and how do you see it showing up in your work?
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How does your practice currently approach serving patients who face barriers to care — such as cost, language, insurance status, or geography? What more do you think the mental health field should be doing?
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SECTION 5 — AREAS OF CONTRIBUTION
In which areas do you feel you could contribute the most? (Select your top three)
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Program design and clinical relevance
Patient access and care navigation
Provider community outreach and engagement
Policy and advocacy
Equity and underserved populations
Research and outcomes measurement
Communications and community education
Other:
If you answered 'Other' to 'In which areas do you feel you could contribute the most? (Select your top three), please explain below.
Is there a specific challenge in mental health care — for patients or providers — that you feel is not getting enough attention? Please describe.
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SECTION 6 — AVAILABILITY & COMMITMENT
Partner Advisory Board members attend two 45-minute meetings per month and participate in at least one meaningful activity per year (such as a working group, feedback session, or collaborative project). This is a volunteer role; members are not compensated.
Can you commit to this?
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Yes
Yes, with some flexibility needed (please explain below)
Preferred meeting format:
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Virtual
In-person
Either works
If you selected 'Yes, with some flexibility needed (please explain below)' on 'Can you commit to this?', please explain below.
Is there anything that might affect your ability to participate that you'd like us to know? (Optional)
SECTION 7 — REFERENCE
Please provide one professional reference.
Name:
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Organization:
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Relationship to you:
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Email:
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Phone:
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SECTION 8 — ANYTHING ELSE
Is there anything else you'd like us to know about you or your interest in this role?
ACKNOWLEDGMENT
By submitting this application, I confirm that the information provided is accurate and complete. I understand that submission does not guarantee membership and that Paperflower Foundation will be in touch regarding the next steps.
Signature
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Date
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