Community Health Advisor Application Form
This application form is intended for Community Health Advisors to the Kansas City, Missouri Health Commission. Your application will be reviewed by the Health Commission Liaison, Dr. Joseph Lightner. Questions about the application process can be directed to Joseph.Lightner@kcmo.org or 816-513-6302. Application does not guarantee an invitation to a committee; if your first choice committee is not available you may be offered a spot on another committee. We at the Kansas City, Missouri Health Commission appreciate your willingness to serve our city!
Please tell us your name: *
Your answer
Home Address (including city, state and zip): *
Your answer
Work Address (including city, state and zip): *
Your answer
E-mail address: *
Your answer
Phone number:
Your answer
Describe your education and other relevant credentials:
Your answer
Current place of employment, including title:
Your answer
I am interested in the following committees: *
Required
Organizational Affiliations (organizations, boards, advisory councils, etc.):
Your answer
Why are you interested in serving as a Community Health Advisor?
Your answer
Commitment Clause
By submitting this application, I am expressing an understanding of the following:

 My membership on a Health Commission Committee will require a commitment of my time regarding monthly meetings, assignments, and reading / reviewing materials
 To be an effective member of the Committee I can expect to spend an average of four (4) hours per month engaging in Committee activities
 The term of the Health Commission’s Community Health Advisors is three (3) years and I may serve two (2) consecutive terms
 Community Health Advisors are expected to attend at least 50% of regularly scheduled meetings
 Within the first year that I become a Community Health Advisor I am expected to attend a Health Commission and Committee Orientation session

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