Equity working group application

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* 1. Please upload your Resume/CV.

This is optional if you are applying based on lived experience. Your answer to question 16 will serve as a resume.

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.

Choose File

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* 2. Name

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* 3. Title and Organization/Employer (optional; if affiliated)

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* 4. Telephone Number

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* 5. Email Address

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* 6. Street address

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* 7. City

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* 8. State

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* 9. Zip code

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* 10. What type of topical expertise do you have (please check all that apply)?

Development of diversity, equity and inclusion initiatives (e.g., at workplace, in health or education setting, in community)

Experience with evaluation and research from an equity lens

Expertise in behavioral health related work in disproportionately impacted/underserved communities (e.g., tribal partners, BIPOC, LGBTQ+, rural populations, populations in juvenile justice, and other groups)

Experience working with children and youth (e.g., infants, early childhood, adolescents, young adults)

Other (please specify)

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* 11. What type of functional expertise do you have (please check all that apply)?

Research and development of equity and inclusion programs, (including health, education, and/or behavioral health focused programs)

Collaboration and coordination with educators, providers, government agencies, academic institutions, or other relevant organizations

Design and implementation of strategies focused on advancing equity in systems, programs, and initiatives at the state and / or local levels (including end-to-end operational support and continuous improvement)

Impact evaluation and data disaggregation from an equity lens

Diversity, equity and inclusion capacity building (e.g., design and implementation of cultural competence, anti-racism and/or other related trainings)

Other (please specify)

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* 12. Which core equity focus area are you most interested in? (RANK in order of preference, 1 is the highest)

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* 13. If you indicated "other" in the previous question, please enter it here.

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* 14. Which role are you most interested in taking on?

Leadership (lead meetings, coordinate with other CYBHI working groups and advisory councils, host technical assistance sessions to help the CYBHI learn about and seek guidance on how to embed equity principles)

Coordination (share information, develop working group processes)

Research (identify best practices and relevant examples, synthesize insights from multiple sources, draft recommendations for the Equity Working Group to consider)

Communication (share information about the working group and its progress on an ongoing basis with the CYBHI and other stakeholders, share equity-related learnings with workstreams, create presentations and other communication materials)

Other (please specify)

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* 15. What about the CYBHI Equity Working Group interests you? (Limit 200 words)

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* 16. What are two or three potential objectives or accomplishments that you would like to see the Equity Working Group achieve? (Limit 300 words)

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* 17. What specific expertise (professionally or personally) would you bring to the Equity Working Group to help build an equitable behavioral health system for children, youth, and their families/caregivers? Please share an example of how you have used your skills and/or knowledge to advance equity in your community or workplace. (Limit 500 words)

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* 18. If offered, would you be available and interested in attending in-person meetings?

Yes

Other (please specify)

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* 19. Attestation and certifications

I certify everything above is accurate, and, if selected as a member of the Equity Working Group, I will commit to collaborating as an active member to advance and embed principles of equity throughout the CYBHI.

To certify, please enter your full name below.

Note: CalHHS reserves the right to invite equity working group members in addition to those selected via the application process. In addition, if not selected, applicants will still have the opportunity to provide input on CYBHI efforts via the broader stakeholder engagement process.

Equity working group application

Question Title

* 1. Please upload your Resume/CV.

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* 2. Name

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* 3. Title and Organization/Employer (optional; if affiliated)

Question Title

* 4. Telephone Number

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* 5. Email Address

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* 6. Street address

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* 7. City

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* 8. State

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* 9. Zip code

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* 10. What type of topical expertise do you have (please check all that apply)?

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* 11. What type of functional expertise do you have (please check all that apply)?

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* 12. Which core equity focus area are you most interested in? (RANK in order of preference, 1 is the highest)

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* 13. If you indicated "other" in the previous question, please enter it here.

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* 14. Which role are you most interested in taking on?

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* 15. What about the CYBHI Equity Working Group interests you? (Limit 200 words)

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* 16. What are two or three potential objectives or accomplishments that you would like to see the Equity Working Group achieve? (Limit 300 words)

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* 18. If offered, would you be available and interested in attending in-person meetings?

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* 19. Attestation and certificationsI certify everything above is accurate, and, if selected as a member of the Equity Working Group, I will commit to collaborating as an active member to advance and embed principles of equity throughout the CYBHI.To certify, please enter your full name below.

* 19. Attestation and certifications

I certify everything above is accurate, and, if selected as a member of the Equity Working Group, I will commit to collaborating as an active member to advance and embed principles of equity throughout the CYBHI.

To certify, please enter your full name below.