MCPS School Health Advisory Board Membership Application

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Thank you for your interest in serving on the MCPS School Health Advisory Board.

This team focuses on health and safety initiatives within the division. We typically meet 3 or 4 times an academic year, but can add additional meetings as necessary.

Please complete this form in order for us to select a balanced and representative team. Unfortunately, we may not be able to select all who apply, as teams can sometimes get too large to be effective. We will use the email your provide on this form for future communication.

Today's Date *

YYYY

Name *

Address *

E-mail Address *

Phone Number *

Are you applying as a: *

Parent/Guardian

Teacher

Student

Community Member

Other:

Required

We are committed to making sure that our advisory committees represent each of our communities. Please indicate the community in which you live so we can ensure that committee membership includes each of our communities proportionally. *

Auburn

Blacksburg

Christiansburg

Eastern Montgomery

We are committed to making sure that our advisory committees represent a cross-section of our community. Please provide your race/ethnicity so we can ensure that committee membership reflects the racial and ethnic makeup of our county proportionally. *

American Indian

Asian

Black

Hispanic

Native Hawaiian

White

Multiple Races

Prefer Not to Answer

Other:

Please give a brief explanation of why you would like to be a part of the School Health Advisory Board. *

What do you hope to accomplish from your participation on the School Health Advisory Board? *

What unique perspectives, talents, or skills would you bring to the School Health Advisory Board? *

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