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2. COMMITTEES*
   -- Select One --Accommodations Tax Advisory CommitteeAirport Development CommitteeACSET CommitteeBuilding AuthorityCommunity Corrections AdvisoryCommunity Mental Health / HealthWest*Department of Health & Human Services (DHHS)Foreign Trade Zone CommitteeLSE Substance Abuse CommitteeLandbank Fast Track AuthorityLibrary Board CommitteeMSU Extension CouncilMuseum BoardPublic Health Advisory CommitteeRoad CommissionSenior Activities CommitteeSolid Waste Planning CommitteeVeterans' Advisory CommitteeWhite River/Natural River Zoning Board

   Please select the Committee on which you wish to be considered. If you would like to be considered for multiple committees, please fill out a form for each.

4. Committee Position (if applicable)

   If there is a specific position opening in this committee, please enter that position name here for consideration.

6. * If HealthWest Board is of interest, please indicate if you have Lived experiences with any of the following:

   1. Mental Illness

   1. Developmental Disabilities

   1. Substance Use Disorder

   (Select all that apply.)
8. Full Name*

   Please enter your full legal name

9. Email Address*
11. Home Address*
13. City*
14. State*
15. Zip Code*
17. Employer Address
19. Employer City
20. Employer State
21. Employer Zip Code
23. Personal Phone*
24. Work Phone
26. Gender
    (voluntary)
27. Ethnicity
    (voluntary)
29. What special experience, education or interest do you have for serving on the board/committee you have selected?*
31. What special skills do you feel you could bring to this committee/board?*
33. What other boards/committees do you currently serve on, or have you served on in the past?*
35. Upload Cover Letter

    Please submit files in PDF format only.

36. Upload Resume
    Please submit files in PDF format only.
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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

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