Backup — original pdf

Backup

Membership Applicant Biographical Sketch The following individual has submitted a membership application to the HIV Planning Council. Liza Bailey (Applicant Name) Patient Care Technician at Family Emergency Rooms OCCUPATION COMMUNITY VOLUNTEER WORK Experience in emergency medicine. Research Assistant for Project Seed at the University of Texas. Kappa Rho member and volunteer coordinator for aspiring female healthcare professionals SKILLS/EXPERIENCE Fluent in Russian. Conversational Spanish skill. Licensed Emergency Medical Technician in Texas. Lived Experience as a child of an immigrant. Public Health Undergraduate at the University of Texas at Austin. COUNTY OF RESIDENCE HRSA MEMBERSHIP SLOT (Check all that apply) Travis Bastrop Caldwell Hays Williamson Health Care Providers, Including Federally Qualified Health Centers Community-based organizations serving affected populations and AIDS Service Organizations (ASOs) Substance Abuse Providers Social Service Providers, including providers of housing and homeless services Mental Health Providers Local Public Health Agency Hospital planning agencies or health care planning agencies Affected Communities, including PLWH/A, members of a Federally recognized Indian tribe as represented in the population, individuals co-infected with hepatitis B or C and historically underserved groups and subpopulations. Non-Elected Community Leaders State Government (including the State Medicaid Agency. State agency and the agency administering the program under part B. Grantees under subpart II of part C (Title II early intervention) Representatives of organizations with a history of serving children, youth, women, and families living with HIV and operating in the area. Grantees under other Federal HIV programs, including but not limited to providers of HIV prevention services Representatives of individuals who formerly were Federal, State, or local prisoners, were released from the custody of the penal system during the preceding 3-years, and had HIV/AIDS as of the date on which the individuals were released. HIV/AIDS Prevention Provider Yes No A AA H W PI Other Reducing Health Disparities Planning Council Recommend? Yes No CONFLICT OF INTEREST RACE/ETHNICITY SPECIAL INTERESTS GMCS Committee Recommend? Yes No  Membership Applicant Biographical Sketch The following individual has submitted a membership application to the HIV Planning Council. Aran Belani (Applicant Name) OCCUPATION COMMUNITY VOLUNTEER WORK SKILLS/EXPERIENCE COUNTY OF RESIDENCE HRSA MEMBERSHIP SLOT (Check all that apply) CONFLICT OF INTEREST RACE/ETHNICITY SPECIAL INTERESTS GMCS Committee Recommend? Yes No Peer Ambassador and Undergraduate Research Assistant at the University of Texas at Austin Civic Engagement Alliance Vice Chair for TxVotes. Undergraduate Research Committee Member for the Senate of College Councils. Longhorn Emergency Medical Service Responder Fluent in Hindi and basic Spanish. Skilled in Microsoft Excel/Powerpoint/Word, R Statistical Software, HTML, Python, and Slicer. Licensed Emergency Medical Technician in Texas. Public Health Undergraduate at the University of Texas at Austin. Certified Volunteer Deputy Registrar in Travis County. Hays Caldwell Williamson Bastrop Travis Health Care Providers, Including Federally Qualified Health Centers Community-based organizations serving affected populations and AIDS Service Organizations (ASOs) Substance Abuse Providers Social Service Providers, including providers of housing and homeless services Mental Health Providers Local Public Health Agency Hospital planning agencies or health care planning agencies Affected Communities, including PLWH/A, members of a Federally recognized Indian tribe as represented in the population, individuals co-infected with hepatitis B or C and historically underserved groups and subpopulations. Non-Elected Community Leaders State Government (including the State Medicaid Agency. State agency and the agency administering the program under part B. Grantees under subpart II of part C (Title II early intervention) Representatives of organizations with a history of serving children, youth, women, and families living with HIV and operating in the area. Grantees under other Federal HIV programs, including but not limited to providers of HIV prevention services Representatives of individuals who formerly were Federal, State, or local prisoners, were released from the custody of the penal system during the preceding 3-years, and had HIV/AIDS as of the date on which the individuals were released. HIV/AIDS Prevention Provider Yes No A AA H W PI Other Medicine, Community Engagement and Public Policy Planning Council Recommend? Yes No