Trauma Informed Care Taskforce Application

 

1 Start 2 Employment/References 3 Questionnaire 4 Complete

Why do you want to serve on the Trauma Informed Care Taskforce? *

Below are a list of qualifications required as a apart of the Elijah Cummings Healing City Act. Please select up to five that you identify with and/or best describes your experience. Applicants should select via checkbox. *

Youth representatives from a youth-led advocacy group in Baltimore City

An individual with at least one child enrolled in Baltimore city public school system

A licensed clinician with an expertise in trauma and healing

Member of the research community with an expertise in trauma and healing

A representative of an organization with an explicit focus on racial equity

An individual between 14-25 years of age

An individual licensed to practice in Maryland as a physician with a specialty in pediatrics

A representative of an LGBTQ advocacy organization

A naturalized citizen or a resident alien

An individual who has recently exited from the Maryland Correctional System

An employee of the Baltimore public school system

A representative from community organizations, nonprofit organizations, or youth organizations that have an expertise in trauma and healing

An individual licensed to practice in Maryland as a Social Worker

Personal Information

First Name *

Middle Name

Last Name *

Suffix

Address Line 1 *

Address Line 2

City *

State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code *

Primary Number *

Email Address *

Have you ever served in the US Armed Forces? *

Yes

No

Residency Information

Are you registered to vote in Baltimore City? *

Yes

No

Registered Political Party

Legislative District * - Select -40th41st43rd44A45th46thI do not live in the city of Baltimore

Council District * - Select -1st2nd3rd4th5th6th7th8th9th10th11th12th13th14thI do not live in the city of Baltimore

Find Your Council District

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