Advisory Board Interest Form

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Kansas CCBHC licensing regulations require Pawnee Mental Health Advisory Board members to meet the criteria of having lived experience with mental illness or substance use disorder, be a family member of an individual with lived experience with mental illness and/or substance use disorder, or must be a community partner, that is a person with lived experience in developing initiatives related to identifying community needs, goals, and objectives.You can help us by marking all statements that apply to you. We realize this is a sensitive topic and this information will be kept confidential. This field is required

I have experience as a community partner in developing initiatives related to community needs, goals, and objectives. (community partner can encompass business owners or chamber of commerce members who have employed someone via IPS services) At some point in my life, I experienced a mental illness or substance use disorder. I am a family member of an individual who experiences or has experienced a mental illness or substance use disorder. I am a family member of an individual who experiences or has experienced a mental illness or substance use disorder. I have been enrolled in, or am the family member of someone enrolled in, Individual Placement Support (IPS). Neither of these situations regarding mental health apply to me or my family. I have served in the military or have a family member who has served.

Advisory Board Interest Form

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