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Foster Care Advisory Committee

    Appointments

    • By the Governor
    • Two members initial term ends March 1, 2014
    • Selected from lists compiled by the Health and Human Services Committee

    Criteria

    • No pecuniary interest in the foster care system;
    • No individual employed by the Foster Care Review office, the Department of Health and Human Services, a county, a child-caring agency, a child-placing agency, or court;
    • One member from a list of four local board members;
    • One member from a list of four persons with data analysis experience;

    Deadline

    • February 1, 2014

    Responsibilities

    • Meet at least four times each calendar year;
    • Oversee the executive director;
    • Support and facilitate the work of the office;
    • Term begins March 1, 2014, or as soon as confirmed



If you are interested in being considered for an appointment to the Foster Care Advisory Committee, please complete this application form.

 
Today's Date
Your Name (required)
Appointment Desired (required)
Please list any other Boards or Commissions which you are currently serving on or previously have served on.
Legal Residence (required) (house number, street name)
City
State
Zip Code
County
Business Address (house number, street name)
City
State
Zip Code
County
Home Phone (required) (Please include area code)
Business Phone (Please include area code)
Cell Phone (Please include area code)
FAX Number (Please include area code)
Email Address (required)
Date of Birth
Place of Birth
Occupation
Name of Spouse
Congressional District
1
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Name of Your State Senator
Have you ever been convicted of a felony or misdemeanor?
Yes No
If yes, please explain:
Are there currently or has there ever been any disciplinary actions, suspensions or revocations of any licenses that you have been issued by any agency of federal, state, or local government?
Yes No
If yes, please explain:
Could you or any member of your family be affected financially by decisions to be made by the committee for which you have applied ?
Yes No
Diversity Information
(To assist in the selection, you are asked to voluntarily provide information, which is necessary for statistical reporting purposes.
Under State and Federal law, this information may not be used to discriminate against you.)
Male
Female
Racial/Ethnic Background
   
Employment
Statutes require some board appointees meet specific employment criteria.
List employment beginning with the most recent experiences.
A resume or additional information is optional.
Employer Location Dates
 
Education
Schools attended including High School:
School Location Dates Major/Degree
 
Additional Information
Please list additional supportive information about yourself, your experiences, and background,
including any board or commission you have served on in the past,
honors or awards you have received, and other volunteer activities.
 
References
List names, addresses, and phone numbers of at least three people who may be contacted for references:
Name (required) Phone Number (required) Address
 

If you have a recently prepared resume or biography, you may fax or email them to Brennen Miller:
Fax: (402) 471-2126 (Please address to Senator Campbell, attention Brennen Miller)
Email :

  

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