MHSA

Prospective Planning Participants' Information


Thank you for your interest in the MHSA planning process.  This process will include limited fixed members Planning Panels for age-groups:  Older Adults, Adults, Transition Age Youth, and Children.

These Planning Panels will be supported by fixed-member Work Groups formed around specific needs and planning issues.  New Work Groups can be formed as the need arises.  The MHSA planning process will depend on and welcomes the active participation of a broad and diverse group of people.

Planning Panels may meet every two weeks.  Work Groups will meet as needed to address specific issues..

All Planning Panels and Work Groups will hold open meetings with time for pubic and stakeholder input.

Please complete the form below if you are interested in becoming a regular member of a Planning Panel or a Work Group.  No form is necessary to attend meetings and provide input as a general stakeholder.

Name    
  First name
  Last name
Address  
  Address
  City           State         Zip 
Phone/Email  
  Telephone
  Email
How would you identify yourself?  
What is your primary language:         Sex: 
Primary Ethnic Identification?           Secondary?  
Organization Name (if any)

Primary business or service 

After reviewing the planning structure and process, please rank you preferred involved:

 Current Planning Panel
  Adult services
 

Children's services
  Transition Age Youth Services
  Older adult services

Future Planning Panels:

  Innovative programs Capital Education & training
 

Early intervention

 Prevention Technology
            

Work Group areas of interest:
                   
Geographic areas Criminal justice population
Ethnic communities Early childhood
Other Specify 
Crisis services Institutionalized populations/shut-ins
Wrap-around services    

  

How frequent can you meet:

Weekly

Twice per month

Monthly
Preferred Meeting Day(s)   

Daytime only

Evening only

Either


What underserved or unserved population can you represent??