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“The Miami-Dade Community Based Care Alliance exists to design, strengthen, and oversee a cohesive system of care that will ensure the safety and well-being of children in a manner that is family centered, community based, integrated, outcome oriented, culturally competent, timely in its responses, and accountable.”
Membership Application
We appreciate your interest in serving as a member of the Miami-Dade Community Based Care Alliance (CBC Alliance). Please review the attached Membership Information and then complete the following questions. Send /fax the completed application and your CV to Candice Maze, Executive Director, Community Based Care Alliance, 401 NW 2nd Ave. S-926C, Miami, Florida 33128. Fax (305) 349-1424.
Name:__________________________________________________________________
Address:________________________________________________________________
Occupation:_____________________________ Telephone: ______________________
Place of
Employment:____________________________________________________________
Email:__________________________________________________________________
Areas of Expertise (please check all that apply):
__accounting __management/business
__health __mental health
__advertising/PR __legal
__education __lobbying
__community relations __child welfare
__others (specify)___________________________________________________Miami-Dade
CBC AllianceMembership ApplicationPage 1
The following questions regarding race/ethnicity will help the CBC Alliance to
ensure the diversity of it membership. Please check one:
__White, non-Hispanic __African American __Caribbean __Asian
__Hispanic/Latino __Haitian __American Indian ___ Other: ____________
Country of Origin____________________ Language/s: ____________________
Please explain why you are interested in serving as a CBC Alliance member:
________________________________________________________________________
Membership on the CBC Alliance requires a two to three-year obligation and a significant time commitment that includes, but is not limited to, attendance at monthly CBC Alliance meetings, active participation in CBC Alliance events and committees and advocacy on behalf of the CBC Alliance in the community. CBC Alliance members will be excused from service should they have more than three unexcused absences from the regularly scheduled monthly CBC Alliance meetings.
Pursuant to Florida law, CBC Alliance members may not receive funding from or work for any organization that receive funds from the Department of Children & Families or Our Kids, Inc. (Florida Statute 20.19(6)(f)).
By signing below, I acknowledge that I have read the attached Membership Information and, if elected to the CBC Alliance, I will fully assume the responsibilities and obligations of a CBC Alliance Member.
_________________________________ ______________
Signature Date
CBC AllianceMembership ApplicationPage 2