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CCPMA Steering Committee Application Form
The CCPMA Steering Committee makes recommendations to Chicago Cultural Performing Arts & Media Alliance for programming and funding. Consumers and Family Members/Caregivers with lived experience are valued and bring an important voice to the CCPAMA Steering Committee.
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ROLE:
CCPMA Steering Committee members are expected to
:
• Effectively and respectfully engage clients, family members, and other community stakeholders through a
broad participation process, including the creation of workgroups, to develop
• Review and rank program proposals developed with stakeholder input; and
• Make specific program recommendations to Chicago Cultural Performing Arts & Media Alliance consistent with CCPMA goals, guidelines, and requirements.
CCPMA Steering Committee meetings are held the 4rd Thursday of each month in person or zoom from 6:00-8:00 pm at
4540 W Washington Blvd
Chicago, IL 60624
Please acknowledge that you are able to attend these meetings regularly.
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Yes, I can attend meetings regularly
No, I will not atted every meetings
Other:
Please share your contact information
First Name:
Your answer
Last Name:
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Your answer
City/Town:
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Your answer
ZIP/Postal Code:
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Your answer
Email address:
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Your answer
Phone Number:
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Your answer
What is your race/ethnicity?
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White or Caucasian
Hispanic or Latino
American Indian or Alaska Native
Black or African American
Asian or Asian American
Native Hawaiian or other Pacific Islander
Which age group do you belong to?
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16-25
26-54
55-59
60+
Are you a consumer and/or a family member/caregiver of a consumer?
Yes
No
Maybe
Clear selection
Check all that you identify with:
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Current or Former Foster Youth
Faith Community/Spirituality
Current or Former Homeless
Veteran
LGBTQ+
Other:
Required
Are you interested in being
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Primary Representative (attend every meeting)
Alternate Representative (attend when requested/needed)
Either
Please tell us about your experience working with other community groups or individuals to improve mental health and wellness in your community.
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Your answer
Please describe your understanding of CCPMA. If you are not familiar with CCPMA, would you be willing to attend training to learn about it?
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Your answer
Every individual has strengths to contribute. What are some of the strengths you would bring to the Steering Committee?
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Your answer
Please provide any additional information about your experience or background that you want us to consider
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Your answer
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