Thank you for your interest in joining the LIFEPlan CCO Member and Family Advisory Council.
Please complete this form to provide information about yourself and your interest in
participating on the council.

Council members agree to attend a minimum of four (4) Council meetings per year, and to
serve for a minimum of 1 year.








Relationship to LIFEPlan member or self advocate*
Why are you interested in joining the Member and Family Advisory Council?

Do you have previous board or committee experience? *

What skills can you offer as a Council member? Check those that apply:

Board developmentStrategic planningStaffing/HRProgram developmentLegalFinancial managementEvaluationCommunity networkingOther ProfessionTrainingMarketingVolunteer managementFacilities management

To print a version of this application click here and mail to:
LIFEPlan CCO MFA Council
258 Genesee Street, Mezzanine Level
Utica, NY 13502