Advisory Council Application | Napa/Solano Area Agency on Aging

Federal and State laws mandate the composition of the Area Agency on Aging (AAA) Advisory Council. The application questions are designed to ensure the legal composition of the Advisory Council.

CLICK HERE if you prefer to download the application and mail it to our office.

Otherwise, please complete the application below.

Advisory Council Application

Name

Date of Birth

Street Address (Home)

City

State

Zip Code

Cell Phone

Home Phone

Personal Email

Business Email

Please indicate which county you are applying to represent:

Napa County

Solano County

Please indicate your membership preference:

Primary Representative

Alternate Representative

No Preference

Please indicate the category for which you are applying and your category affiliation (if applicable):

Representatives of older individuals

Representative of health care provider organizations, including providers of veterans’ health care

Representatives of supportive services provider organizations.

Persons with leadership experience in the private and voluntary sectors.

Local elected officials

Family caregiver representative

The general public

Health care organization affiliation:

Supportive Services organization affiliation:

Leadership Experience

Elected position

Term Start Date

Term End Date

Upload Resume or CV

Upload requirements

Please indicate your race and ethnicity:

White

Hispanic

Asian

Black

Native Hawaiian/Pacific Islander

American Indian

Other…

List other:

Supervisorial District in which you reside

The following links can be used as a reference for Supervisorial District information:

Solano County:
http://www.solanocounty.com/depts/rov/district_maps_and_lookup/districtlookup.asp

Napa County (select “My District” from the link below): https://www.countyofnapa.org/2116/Board-of-Supervisors

The Advisory Council meets monthly on the first Tuesday of the month. Meetings are held from 10:00 am – 12:00 noon. Meeting locations are in Napa and Solano Counties. Members may be asked to attend quarterly meetings of the AAA Oversight Board and monthly subcommittee meetings.

Please indicate any obstacles you may have with regard to meeting attendance (example: “I am not able to meet on Mondays or Wednesdays”):

Memberships in other organizations or committees or other community participation (list name and address and nature of organization/committee or community participation):

Please provide a brief description of your employment and educational history (you can also upload your resume or CV)

Three References

Name

Relationship

Phone Number

Name

Relationship

Phone Number

Name

Relationship

Phone Number

Why do you want to serve on the Advisory Council?

Applicant's Signature

Name

Date