Community Advisory Board Member Application

Thank you for considering service on the Fort Bend County Clinical Health Services HIV/STI (FBCCHS HIV/STI) Prevention Program Community Advisory Board (CAB). The purpose of the CAB is to work in partnership to achieve program goals. The CAB assists in programmatic decisions and provides guidance to the program in identifying opportunities to better serve priority populations. At quarterly meetings, CAB members provide feedback on various topics to assist in guiding program activities; thus ensuring grant deliverables and the needs of the community are met.

We are very happy to have you consider joining. Most members find the experience professionally and personally enriching. Please respond to the following questions to help us understand your potential contribution and to help us maintain diversity. HIV+ individuals are encouraged to apply. Please use extra space, as needed, and include a resume or CV.

Questions? Contact Juston.Baze@fortbendcountytx.gov
Also, please see our webpage for more information about the CAB: Fort Bend County Clinical Health Services

***Please note: We are currently updating our website. More details to follow***

Name:*

First Last

Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone:*

Email:*

1. Why do you want to become a member of the FBCCHS HIV/STI Community Advisory Board (CAB)?*

2. Please describe your relevant experiences in HIV prevention.*

3. Please discuss the relevant networks to which you have access.*

4. Please discuss the relevant communities of which you are a part.*

Please select the time commitments you are able to fulfill.*

Hold CTRL on your keyboard to select multiple options.

Age: (Optional)

Pronouns: (Optional)

Ethnicity: (Optional)

HIV Status: (Optional)

Additional Comments: (Optional)