Benton Franklin Behavioral Health Advisory Committee Application Form

Benton Franklin Behavioral Health Advisory Committee Application Form
On March 1, 2022, the Boards of Benton and Franklin County Commissioners approved the formation of the Benton Franklin Behavioral Health Advisory Committee. The purpose of the committee is to gather input on the behavioral health needs of the community and to provide recommendations to the Boards of County Commissioners on how to best spend the revenues generated by the 0.1% sales tax for chemical dependency or mental health treatment services.

Voting members will be appointed by each county from the following categories:
- Experts or practitioners in Mental Health (1)
- Experts or practitioners in Substance Use Disorder (1)
- Persons with lived experience (1)
- Hospital Emergency Room Managers (1)
- Law Enforcement and Corrections (1)
- Fire Departments and Emergency Medical Responders (1)
- Community Members / General Public (2)
Please complete this form if you are interested in being considered for one of the following available positions:
- Community Member / General Public (2 available)
- Persons with lived experience (1 available)
  
  Defined as a person who is: a certified peer counselor, in recovery themselves for at least one year, or has close family members with substance use disorder and/or mental health issues.
- Expert or practitioner in mental health
If you have any questions about this form or the advisory committee, please contact:
- Benton County: Matt Rasmussen, Deputy County Administrator - Matt.Rasmussen@co.benton.wa.us or 509-786-5600
- Franklin County: Keith Johnson, County Administrator - kjohnson@franklincountywa.gov or 509-545-3578
Preferred Contact Method*

EmailPhone
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please indicate whether you are applying for consideration to be appointed by Benton County or Franklin County:*

Benton CountyFranklin County
Which position are you interested in?*

Community Member / General PublicPersons with Lived ExperienceExpert or Practitioner in Mental HealthExpert or Practitioner in Substance Use Disorder
Why are you interested in being a member of the Benton Franklin Behavioral Health Advisory Committee?*
Please list any relevant work or life experience that qualifies you for being a member of this committee.*
Individuals applying for Expert/Practitioner in Mental Health or Expert/Practitioner in Substance Use Disorder are required to attach a copy of their resume and a letter of interest.

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