Dedicated to protecting and improving the health and environment of the people of Colorado

MEMORANDUM To: Assisted Living Providers and Consumers of Assisted Living Services From: Elaine McManis, Branch Chief, Home and Community Facilities The Health Facilities and Emergency Medical Services Division of the Colorado Department of Public Health and Environment is currently accepting applications for Colorado Council on Assisted Living members. Per statutory requirements, Colorado Council on Assisted Living members serve on a voluntary basis and are appointed by the Executive Director of the Colorado Department of Public Health and Environment. This committee represents providers and consumers of assisted living residential services, the Colorado commission on the aging, county, district, or municipal public health agencies, or local boards of health, and consumer and other agencies and organizations providing service to or concerned with residents of assisted living residences. The Colorado Council on Assisted Living members meet to review and discuss the rules that govern the licensing of assisted living residences in the State of Colorado and make recommendations to both the Colorado Department of Public Health and Environment and the State Board of Health. Currently the council meetings are held once each month for two hours. If you are interested in serving as a council member, please complete the application included with this notice and fax or mail it to:

Colorado Department of Public Health and Environment Health Facilities and Emergency Medical Services Division 4300 Cherry Creek Drive South Denver, CO 80246 ATTENTION: Elaine McManis Fax: 303-753-6214

4300 Cherry Creek Drive S., Denver, CO 80246-1530 P 303-692-2000 www.colorado.gov/cdphe John W. Hickenlooper, Governor | Larry Wolk, MD, MSPH, Executive Director and Chief Medical Officer

Dedicated to protecting and improving the health and environment of the people of Colorado

APPLICATION TO SERVE AS A MEMBER OF THE COLORADO COUNCIL ON ASSISTED LIVING

Name: ________________________________________ Telephone number: ______________________________ Email: ________________________________________ Professional Credentials (if applicable): _____________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

Currently employed with an assisted living facility Previously employed with an assisted living facility Currently or previously a consumer of assisted living services

Name of associations, organizations or groups you hold membership with: (Please include if you are a member of the Colorado Commission on the Aging, associated with a county, district, or municipal public health agency, local boards of health, or other agency and/or organizations providing services for or on behalf of residents of assisted living residences.) _____________________________________________________________________________________________________________________

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Please attach a resume and a statement about why would you like to participate as a committee member. Mail or fax your completed application to: Elaine McManis, Branch Chief Home and Community Facilities Branch Health Facilities and Emergency Medical Services Division 4300 Cherry Creek Dr. South, Denver, CO 80246-1530 [email protected] / 303-753-6214

4300 Cherry Creek Drive S., Denver, CO 80246-1530 P 303-692-2000 www.colorado.gov/cdphe John W. Hickenlooper, Governor | Larry Wolk, MD, MSPH, Executive Director and Chief Medical Officer