SHIP 2021-2026 Planning Well-Being Workgroup

Please provide the following:

Name:

Email:

Representing (name of CHB or organization):

Workgroups co-chair duties include:
·         Chair meetings
·         Review meeting agendas
·         Communicate with members between meetings
·         Suggest sub-workgroups as needed

I am interested in being a co-chair  for the SHIP 2021-2026 Planning Well-being Workgroup:  (Check if interested)

1. Yes

I represent the following: (Check all that apply)

1. Greater Minnesota, rural areas
2. Greater Minnesota, urban areas
3. Metropolitan area
4. Tier One SHIP grantee
5. Tier Two SHIP grantee
6. Tier Three SHIP grantee
7. Experience with disparately impacted populations
8. MDH
9. Partner organization

I am able to attend all meetings currently scheduled in their entirety: 

1. Yes
2. No