PBHAC Board of Directors Application
Please complete the following form and the indicated steps to apply to serve as a member of the Coalition's Board of Directors.
The deadline to apply for a position on PBHAC's Board of Directors ended on Friday, January 23. Feel free to complete the following application and you will be considered for the 2016 Board openings. Thank you!
You have two options to complete an application to serve on our Board of Directors. You may complete the form online by answering the questions below. If you prefer to download a Word application, please download the application from the following link:
Please enter your complete home address, including Street, City, State and Zip Code
County of Residence
Personal Email Address
Company (If applicable)
If not working or retired, please indicate this
Title (If applicable)
Please include entire work mailing address, including street, city, state and zipcode
Primary County of Work
I prefer to be contacted at the following email address:
I prefer to be contacted at the following phone number:
Please check all in which you have expertise or experience:
Please check all that apply
Advertising & Creative
Mental Health System
Substance Abuse System
Other Social Service System
Our Goal is to include older adults and consumers as important members of the Board of Directors. If you are willing, please indicate this below:
I am an older adult
I am a past or present consumer of behavioral health services
Are you now serving as a board member of another non-profit organization? If yes, please specify:
Why are you interested in serving on the Board of Directors?
What areas of expertise or contributions do you feel you can contribute to PBHAC?
How do you think the PBHAC Board mightbest take advantage of your expertise?
Additional comments or questions for the PBHAC Board:
Please send your resume or bio to the following: Email -
; Fax - 717-370-6016; USPS - PBHAC 525 South 29th Street. Harrisburg, PA 17104
I will send my resume or bio
I do not have a resume or bio
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