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Required format:

kZWUQjVwXQk7wrYQgfq6YmqPhj57THtvYgmCAUkKKnjQQi3duUAVDvEjD4INPaFDddFj9VxKv

Support Center Community Advisory Board Application

Returning?

A A A

PLEASE NOTE: we are not actively recruiting at this time but if you fill out an application, we will keep it on file and reach out when we are looking to add members to the board.

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 need help filling out the application or creating/updating a resume, you can contact Eileen Timoney, the Career Specialist at the Plymouth Support Center. Her email address is etimoney@baystatecs.org and the Support Center phone number is 508-830-3910.

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:

* must provide value

Preferred Name:

Please indicate your gender:

* must provide value

Male

Female

Non-binary, genderqueer, transgender or genderfluid

An identity not listed

Prefer not to answer

reset

Please self-identify:

* must provide value

Please indicate your preferred pronouns?

* must provide value

She/Her/Hers

He/Him/His

They/Them/Theirs

Other pronouns or combination

Prefer not to answer

What are your preferred pronouns?

Please indicate your ethnicity.

* must provide value

Hispanic or Latino/a/x

Non-Hispanic or Latino/a/x

Prefer not to answer

reset

Please indicate your race (check all that apply):

* must provide value

American Indian/Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Self-Identified

Prefer not to answer

Please specify how you identify.

Please enter your contact details:
Address Line 1

* must provide value

Address Line 2

City:

* must provide value

State (if not MA)

Please indicate your email address:

* must provide value

Please indicate your phone number

* must provide value

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

* must provide value

Text

Phone Call

Please indicate your age in years:

* must provide value

Are you currently involved with a Community Justice Support Center?

* must provide value

Yes

Prefer not to answer

reset

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

* must provide value

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 been involved at a Support Center in the past?

* must provide value

Yes

Prefer not to answer

reset

Which Support Center were you involved in in the past?

* must provide value

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.)?

* must provide value

Yes

Prefer not to answer

reset

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

* must provide value

Yes

reset

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

* must provide value

Yes

Unsure

reset

Have you served on an Advisory Board before?

* must provide value

Yes

Prefer not to answer

reset

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

* must provide value

Expand

Tell us about yourself (5 to 7 sentences):

* must provide value

Expand

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)

* must provide value

Expand

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)

* must provide value

Yes

Unsure

reset

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?

* must provide value

Yes

reset

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

* must provide value

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?

* must provide value

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]

* must provide value

Expand

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.

Upload file

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