SEMHAC Membership Application

Southeastern MI HIV/AIDS Council (SEMHAC) is an HIV/AIDS Planning Council (within the City of Detroit’s Health Department) for Ryan White Part A and MAI funds in the Detroit Metropolitan Area which represents the City of Detroit, and the counties of Wayne, Oakland, Macomb, Monroe, St. Clair, and Lapeer. Council members, who are appointed by the Detroit Mayor (or Mayor’s designee), have a legislative mandate to provide leadership in the development, implementation, monitoring, and evaluation of HIV/AIDS care-related projects, to assess the needs within the area, and to develop strategies to address identified needs and gaps in available services.


Applicants should have an interest in, and/or personal experience with, HIV/AIDS. Individuals seeking membership must be willing to commit the necessary time to attend meetings (monthly & bi-monthly), on a voluntary basis. They should understand the care-delivery system, can help set priorities for system elements, offer insight on improving the system and contribute to the effective delivery of services. They MUST RESIDE in one of the counties listed above to apply.


SEMHAC is seeking members with expertise in various fields, in addition to persons who represent the cultural diversity and demographics of the affected populations. The information provided will be used to select members to the Southeastern Michigan HIV/AIDS Council (SEMHAC).


All information provided will be kept confidential.

Applicant Information

Phone

Employer Information

Phone
Phone

Membership Information

Select which level of membership you are applying for.*

Primary Membership - members have full voting privileges.


At-Large Membership - members are able to vote within standing committees.

Demographics and Representation

Select
Caret IconCaret symbol

Please note: the race/ethnicity and HIV transmission categories on this form are those used for the Center of Disease Control (CDC) AIDS surveillance. The information you provide on this form will be (anonymously) combined with that of other people across our community and the nation, and we therefore ask that you select the categories with which you most closely identify, even if you don’t use identical language in describing yourself.

If how you represent yourself is not listed, type in below.

Select or enter value
Caret IconCaret symbol

With the exception of State Government Representatives, members must reside within the EMA.

Select
Caret IconCaret symbol

If your race/ethnicity is not listed, type in below.

Select or enter value
Caret IconCaret symbol
Select
Caret IconCaret symbol
What is your HIV/AIDS status?*
Are you currently receiving Ryan White Part A services?*

Tell Us About Yourself

Select all that apply. To learn more about each standing committee, click here.

How did you hear about us?

If not listed below, type it in.

Select or enter value
Caret IconCaret symbol

I have read the Southeastern Michigan HIV/AIDS Council Qualifications for Membership statement. I am willing to commit the time and effort to actively participate in Planning Council meetings and activities, as well as, volunteer for at least one of the Committees, should I be selected for service. I understand that my signature below indicates that I’ve answered the questions contained within this document truthfully, and to the best of my knowledge.

This will serve as your signature to the above statement.

Powered by Smartsheet Modern Logo On Light
Privacy Notice|Report Abuse