Support Center Community Advisory Board Application

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Required format:

Thank you for your interest in joining the Support Center Community Advisory Board (CAB). Please fill out the application below to be considered for the position of CAB Member. If you need to save your application and return to it later, please be sure to write down the access code you will be given after clicking the "save and return later" button at the bottom of the application. If you cannot remember your access code, please email Michelle Crist at Michelle.Crist@UMassMed.edu. You will also have an option to upload a resume, cover letter, or other supporting documents at the end.

If you have any questions about the CAB application process, you can email us at Michelle.Crist@UMassMed.edu. More information about the CAB can be found at https://macoe.org/support-center-community-advisory-board.

First and Last Name:

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Preferred Name:

Please indicate your gender:

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Male

Female

Non-binary, genderqueer, transgender or genderfluid

An identity not listed

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Please self-identify:

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Please indicate your preferred pronouns?

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She/Her/Hers

He/Him/His

They/Them/Theirs

Other pronouns or combination

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What are your preferred pronouns?

Please indicate your ethnicity.

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Hispanic or Latino/a/x

Non-Hispanic or Latino/a/x

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Please indicate your race (check all that apply):

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American Indian/Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Self-Identified

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Please specify how you identify.

Please enter your contact details:
Address Line 1

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Address Line 2

City:

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State (if not MA)

Please indicate your email address:

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Please indicate your phone number

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What is your preferred method of contact? (check all that apply)

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Text

Phone Call

Please indicate your age in years:

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Are you currently involved with a Community Justice Support Center?

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Yes

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Which Support Center are you currently involved at? (check all that apply)

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Barnstable

Boston

Brockton

Dartmouth

Fitchburg

Framingham

Greenfield

Haverhill

Lawrence

Lowell

Lynn

Northampton

Pittsfield

Plymouth

Quincy

Salisbury

Springfield

Taunton

Woburn

Worcester

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Have you been involved at a Support Center in the past?

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Yes

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Which Support Center were you involved in in the past?

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Barnstable

Boston

Brockton

Dartmouth

Fitchburg

Framingham

Greenfield

Haverhill

Lawrence

Lowell

Lynn

Northampton

Pittsfield

Plymouth

Quincy

Salisbury

Springfield

Taunton

Woburn

Worcester

Prefer not to answer

Have you ever been impacted by the Massachusetts police, courts, and/or corrections system (e.g. you have been arrested, you have had a family member been arrested, etc.)?

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Yes

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Do you have access to a computer and internet so that you can participate in the virtual meetings?

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Yes

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Will you be able to participate in virtual meetings once monthly starting in March

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Yes

Unsure

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Have you served on an Advisory Board before?

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Yes

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Please describe the advisory board you previously participated in and your role:

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Tell us about yourself (5 to 7 sentences):

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Why are you interested in becoming a member of the CAB? How do you think you can contribute to the activities of the board? (5 to 7 sentences)

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If hired as a member of the CAB can you commit to 12 months with the CAB? (meetings are monthly for 2 hours each month virtually using Zoom)

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Yes

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9:00 am

10:00 am

11:00 am

12:00 pm

1:00 pm

2:00 pm

3:00 pm

4:00 pm

5:00 pm

6:00 pm

7:00 pm

8:00 pm

Monday

Tuesday

Wednesday

Thursday

Friday

Do you give consent for us to keep your application on file to fill future vacancies on the board or to contact you about other engagement opportunities?

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Yes

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How did you hear about the Community Advisory Board? (check all that apply)

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Community Justice Support Center

Probation/Parole/Superior/District Court

Newsletter / Social Media

Virtual information session

Other

How did you hear about the Community Advisory Board?

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Please identify one reference. A reference is a person who can speak to your character or aspects of you that would benefit the Community Advisory Board.

[Reference First and Last Name]
[Reference Email]
[Reference Phone Number]
[Relationship to person providing referral]

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Please attach a resume, cover letter, or other supporting documents.

Upload file

Please attach a resume, cover letter, or other supporting documents.

Upload file

Please attach a resume, cover letter, or other supporting documents.

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