COMMUNITY ADVISORY COUNCIL : APPLICATION

Community Advisory Council Application

County

Tribal Affiliation (optional)

Oregon Health Plan (OHP) Status: Check all that apply)

I have OHP. My Card is with...

My Child or dependent has OHP. Their card is with...

How did you hear about this opportunity

Would you be interested in learning more about opportunities to serve on the WIllamette Health Council Board of Directors, Clinical Advisory Panel, or Community Impact Committee?

8 + 2 =

For any questions, concerns, or help completing this application, please contact Sarah Smith (she/her) at 503-569-0341 ssmith@willamettehealthcouncil.org