Thank you for your interest in the System of Care Advisory Council (SOCAC). As we welcome you into this work, it's helpful to know a little bit about you and why you want to get involved. Please only share what you feel comfortable with; inclusion in this work is not dependent on the information you provide. Information shared will be reviewed by SOCAC staff and SOCAC co-chairs. If you need assistance completing this form or would like to share this information in another format, please email statewide.soc@oha.oregon.gov.

Before completing this form, please ensure you meet the following criteria:

· You live or work in Oregon, AND have reviewed the SOC website

AND

· As a family member, you have a child who is currently or has been involved in two or more systems,
OR
· As a youth member, you are between the ages of 14-26 years old and have been involved in two or more systems,
OR
· You work for a child or family serving agency or organization.

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* 1. What is your (preferred) name?

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* 2. What is your email?

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* 3. What is your phone number?

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* 4. What is the best way to contact you?

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* 5. What county do you live in?

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* 6. Are you engaging with SOCAC as a representative of your employer?

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* 7. If so, who is your employer?

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* 8. What experiences, professional and/or personal, are you bringing to this work? This question helps ensure people with lived experience are represented.

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* 9. Please speak to how your background has shaped your experiences. You might consider things like disability, race, culture, gender identity, sexual orientation, socioeconomic status, geography, urban/rural, farming, military, etc. This is not an exhaustive list. This question helps us understand the variety of perspectives and experiences in our work.

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* 10. What are your reasons for wanting to join the SOCAC? This question helps ensure your interest aligns with SOCAC values and priorities.

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* 11. Is there anything else you want to share? This question helps to ensure we didn't miss anything in this form.

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* 12. As most SOCAC meetings are conducted online, a phone, laptop or tablet, and connection to WiFi are needed to meaningfully participate. Do you have access to these things?

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* 13. If you answered no to question 11, please explain. SOCAC staff are happy to talk with you about equipment and technology access.

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* 14. What additional support or accommodations can we provide to assure you can fully engage in the SOCAC?

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