Stakeholders

We are looking for ideas and feedback from consumers and stakeholders. The Coalition will give equal consideration to everyone who expresses interest in participating, however completion of a "Statement of Interest Form" does not guarantee an appointment to a Committee. Information on this website is only available in electronic format. If you need a paper copy, please contact your local Human Services Agency for assistance. (See the Contact Us link on this website.)

 
Stakeholder Statement of Interest * indicates required fields

* Name:
* Address:
* City:
* State:
    * Zip Code:
* County:
Phone (Home):
Phone (Work):
* Please indicate your
key interest:
 Managed Care Organization & Governance
 ADRC Development
 Communications & Consumer Input
 Care Managment Service Integration & Staffing
 Provider Network and Workforce Development
 Needs/Risk/Capitation Rate Setting
 Infrastructure Financial Contracting - IT
 Quality Management System
Other areas of interest:
* Please list reasons for
interest or qualifications:
* Please indicate how you
would like to participate:
 Participating as a member of a subcommittee
 Making yourself available as a resource to provide information
 Being notified of meetings and progress
 Other
Other ways to particpate
(optional):
* E-mail:
* Preferred method of
contacting you: