LHIC Interest Form

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LHIC Interest Form

Thank you for your interest in the Harford County Local Health Improvement Coalition. Meeting dates will be posted on our website and are open to the public.

First Name *

Last Name *

What best describes you? *

An individual from Harford County

A representative from an organization that serves Harford County

Other:

Who is your employer? *

What workgroups are you interested in? (Select all that apply) *

MHAAC | LHIC | OIT - Behavioral Health

Chronic Disease Prevention and Wellness

Family Health and Resiliency

Required

Email Address *

Mailing Address *

Phone Number *

Please select your anticipated involvement level with the Harford County LHIC over the next year *

I am interested in joining the LHIC to provide input on addressing the county's health priorities, to learn more about the resources available in Harford County, and to attend full LHIC meetings (currently scheduled every two months).

I am interested in joining the LHIC to provide input on addressing the county's health priorities, to learn more about the resources available in Harford County, to attend full LHIC meetings (currently scheduled every two months), and to participate in one or more of the LHIC's workgroups or subcommittees.

I am interested in joining the LHIC to provide input on addressing the county's health priorities, to learn more about the resources available in Harford County, to attend full LHIC meetings (currently scheduled every two months), to participate in one or more of the LHIC's workgroups or subcommittees, and commit my individual resources to further LHIC priorities.

Other:

If there were one thing the LHIC could do to improve health outcomes and/or reduce health disparities, what would it be?

Optional comments

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