GSHS Community Advisory Committee Application Form

Community Advisory Committe Member Application Form

Thank you for your interest in joining our Community Advisory Committee. Without people like you, our service does not benefit from the input of our community, and we sincerely thank you for your time and effort completing this application form.
Your Details
Name*

TitleFirst NameLast Name
Preferred Name
Gender
Pronouns - please specify if you feel comfortable
Are you Aboriginal or Torres Strait Islander?
Address

Street Address

Street Address Line 2

CityState

Post Code
Best Contact Number*

Area CodePhone Number
Email*
example@example.com
Preferred Contact

Community Advisory Committee Member Overview
The South Gippsland Shire Estimated Resident Population for 2022 is 30,680 The CAC provides consumer, carer and community perspectives and views to assist Gippsland Southern Health Service in planning and implementing safety, quality, and service improvements.

GSHS will engage the assistance of the Community Advisory Committee (CAC) to increase consumer, carer, and community participation across the health service. Membership of the Community Advisory Committee will reflect consumers and communities, not health care providers.

If you're passionate about the health of your community, making improvements to services, sharing knowledge and information, and volunteering in a team environment with shared goals, this opportunity is for you.
Can you tell us why you are interested in joining our Community Advisory Committee?
What skills and abilities do you think that you would bring to our Community Advisory Committee?
How long have your lived in the South Gippsland Community?
Can you tell us about your connection with Gippsland Southern Health Service, for example, have you been a patient before?
Can you commit to regular meetings, once every two months for up to two hours?
Pre reading may be required before meeting attendance. Do you need this information provided in any special format or support with this, for example, with bigger text?
Do you belong to any other advisory or community groups, if yes can you please name?
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Community Advisory Committe Member Application Form