» About » Board of Directors » Join The Board Board of Directors Application Applicant InformationName(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) Professional BackgroundCurrent Employer(Required)Job Title(Required)Previous Relevant Experience (professional, volunteer, or board service):(Required)Interest in Board ServiceWhy are you interested in serving on the RMHC Board of Directors?(Required)What skills, expertise, or perspectives would you bring to the board?(Required)Community InvolvementPlease list any community organizations, boards, or committees you are currently involved in or have participated in:Board Expectations & CommitmentBoard members are expected to: • Attend monthly board meetings • Actively participate in committees as needed • Advocate for RMHC and its partner agencies • Support the mission, vision, and values of RMHC • Maintain confidentiality and act in the best interest of the organizationAre you able to meet these expectations?(Required) Yes No CCBHCRange Mental Health Center is a Certified Community Behavioral Health Clinic (CCBHC), a state-certified provider of comprehensive, integrated mental health and substance use disorder services designed to serve as a “one-stop-shop” for care, regardless of an individual’s ability to pay. As a CCBHC, Range Mental Health Center provides 24-hour crisis services, evidence-based treatment practices, and care coordination to improve access and outcomes for underserved communities. In accordance with CCBHC Organizational Authority, Governance, and Accreditation standards (6.B), at least 51% of the governing board must be comprised of individuals with lived experience of mental health and/or substance use disorders, or family members of individuals with such lived experience.Please indicate whether you or an immediate family member have lived experience with mental health and/or substance use disorder:(Required) Yes No Additional InformationDo you have any potential conflicts of interest to disclose?Is there anything else you would like us to know?ReferencesReference 1 Name(Required)Relationship(Required)Phone/Email(Required)Reference 2 Name(Required)Relationship(Required)Phone/Email(Required)Applicant AcknowledgmentI certify that the information provided in this application is accurate and complete to the best of my knowledge.(Required) I agreeType Full Name to Sign(Required)Date(Required)CAPTCHAThank you for your interest in supporting Range Mental Health Center and the communities we serve.
