Assisted Living Advisory Committee (ALAC) Member Appointment Interest Form
Per statutory requirements, the Assisted Living Advisory Committee members serve on a voluntary
basis and are appointed by the Executive Director of the Colorado Department of Public Health
and Environment, as determined through an application process. The Division accepts applications for committee appointment on a continuous basis.

The committee represents providers and consumers of assisted living residences, the Colorado Commission on the Aging; county, district, or municipal public health agencies, or local boards of health, and consumer and other agencies and organizations providing service to or concerned with residents of assisted living residences. As an advisory body, the committee makes recommendations to the Department and Board of Health, but does not have the authority to adopt, enact, or implement rules or policies.
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Email *
First and Last Name *
Telephone Number *
Email Address *
Affiliated Facility or Company *
Professional Credentials (if applicable) *
Name of associations, organizations or groups you hold membership. Include if you are a member of the Colorado Commission on the Aging, associated with a county, district, or municipal public health agency, local boards of health, or other agency and/or organizations providing services for or on behalf of residents of
assisted living residences. *
Committee Composition: What is your area of representation? *
If you are an Assisted Living Residence Representative, please list licensed bed capacity.   *
If you are an Assisted Living Residence Representative, does your residence accept Medicaid funds?  *
Please add a statement about why would you like to participate as a committee member. *
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