Department of Health and Human Services
 

Milwaukee County Commission on Aging

Milwaukee County Commission on Aging

Please fill out the form below if you are interested in serving on the Milwaukee County Commision on Aging or one of its committees. The Commission currently has a number of standing committees and councils including: Advocacy Committee, Service Delivery Committee, Wellness Committee, Advisory Council and the Nutrition Council. 

Full Description of Committees

*Name:
Organization/Affiliation:
*Address:
*City:  *State:
*Zip:
Phone (Home):
Phone (Mobile):
Email:

 

I would like to be considered for membership on the following:
I am 60 years of age or older.   Yes  No
I use service(s) provided by the Milwaukee County DHHS Division on Aging.   Yes  No
Race:
Ethnicity: 

 

Do you work for or serve on any of the following:
  • The Board of Directors for any organization that contracts with the Milwaukee County DHHS Division on Aging   Yes  No
  • A provider of health care for older adults  Yes  No
  • A provider of social or supportive services for older adults   Yes  No
  • A provider of health care or social services to veterans   Yes  No
If you answered yes to any of the above, please specify what organization. 
 
Do you have prior leadership experience in the private or nonprofit sector?  If so, briefly describe.

Are you now serving, or have you in the past served, as an elected official?   Yes  No

 

Please describe briefly your interest in and involvement with older adults in Milwaukee County.

 
If appointed, I agree to participate fully in the work of the select Commission, Board, Council or Committee; attend regularly scheduled meetings; identify any potential conflict of interest; and participate within the scope, ethics, rules and laws governing such bodies.
I agree         I cannot commit at this time.

 

 

 

MILWAUKEE COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES

1220 W. Vliet St.

Suite 301

Milwaukee, Wisconsin 53205

Access DHHS 

How We Help

Our Vision

Together, creating healthy communities.

Our Mission

Empowering safe, healthy, meaningful lives.

Our Values

Partnership, Respect, Integrity, 

Diversity, Excellence

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