HHSC is accepting applications for representatives to serve on the Texas Nonprofit Council.

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1 HHSC is accepting applications for representatives to serve on the Texas Nonprofit Council. Background The Texas Nonprofit Council was established by S.B 993 during the 83 rd Legislation Session in The purpose of the Council is to assist the State with faith-based and community-based initiatives, and help direct the work of the Interagency Coordinating Group (ICG). The Council, in coordination with the ICG will (1) make recommendations for improving contracting relationships between state agencies and Faith- and community-based organizations, (2) develop best practices for cooperating and collaborating with faith- and community-based organizations, (3) identify and address duplication of services provided by the state and faith- and community-based organizations and (4) identify and address gaps in state services that faith- and community-based organizations could fill. The Council will be comprised of 12 individuals representing the following groups: statewide nonprofit organizations, local governments, faith-based groups, community-based groups, consultants to nonprofit corporations, and statewide associations of nonprofit organizations. The Council will prepare a biennial report detailing the council's work, including in the report any recommendations relating to legislation necessary to address an issue identified by the Council. Members Applications are being accepted from representatives of statewide nonprofit organizations, local governments, faith-based groups, community-based groups, consultants to nonprofit corporations, and statewide associations of nonprofit organizations. Each member will serve a three-year term, beginning On October 1 of that term year. No member will serve for more than two consecutive terms. Membership on the Council requires participation in Council meetings. At least three meetings of the Texas Nonprofit Council will be held in Austin, Texas each year, and may extend through August Members will not receive compensation for participation on the Texas Nonprofit Council. Council members will not be reimbursed for travel expenses. To apply Send a completed application to: Deborah Ballard Texas Health and Human Services Commission 909 W 45 th, Building 555 Mail Code 2010 Austin, TX Fax: deborah.ballard@hhsc.state.tx.us *Applications must be received no later than close of business August 30, 2013.

2 Texas Health and Human Services Commission Application for: TEXAS NONPROFIT COUNCIL Please complete this application in a brief yet informative manner. Eligibility will be determined from the information submitted on this application. No resumes will be considered. If questions are not applicable, enter NA. Completed applications must be received no later than Friday, August 30, [Reference: Name: Home Address: City: State: Phone: Zip: Employment Information Organization Name: Supervisor s Name: Address: Phone: Send Correspondence to: Home Are you 18 years Work of age or older? Yes No Applying as a representative for (select one) Statewide Nonprofit Organization Local Government Faith-Based Organization Community-Based Organization Consultant to Nonprofit Corporation Statewide Association of Nonprofit Organizations Education Information (highest level completed first) School Name: Degree: School Name: Degree: Field of Study: Field of Study: Optional Gender: Male Race/Ethnicity: How were you notified of this application? Female HHSC Website HHSC Distribution List HHSC Staff Other: American Indian/Alaskan Native Black White Asian/Pacific Islander Hispanic Other: Page 1 of 4

3 1) Why do you wish to serve on the Texas Nonprofit Council? 2) Please describe any personal or professional experience with the nonprofit sector that makes you uniquely qualified to serve on the Texas Nonprofit Council: 3) Please describe any educational and/or leadership/advocacy training background that may be relevant to serving on the Texas Nonprofit Council: 4) Have you ever been disciplined by any licensing board/professional or civic organization, including the Office of Investigation and Enforcement for Medicaid/CHIP? Yes No If yes, please explain: Page 2 of 4

4 5) Have you ever been convicted of a felony or a misdemeanor (excluding traffic violations)? Yes No If yes, please explain: 6) Please list any potential conflicts of interest: Page 3 of 4

5 Please provide name, telephone number, and address of two references (references may include employers, clients, religious leaders, community leaders, other parents, etc.). Reference #1: Name: Phone: Reference #2: Name: Phone: I attest that all information contained in this document is true and correct. I understand that the Texas Nonprofit Council will meet at least three times per year in Austin, Texas. If selected, I will commit to make every effort to attend all Texas Nonprofit Council meetings, and I understand that there is no compensation for participating or traveling to Council meetings. Signature of Applicant: Date: Please submit applications to: Deborah Ballard Texas Health and Human Services Commission 909 W 45 th Street, Building 555 Mail Code 2010 Austin, TX Fax: (512) or deborah.ballard@hhsc.state.tx.us If you have any questions about the application or the Texas Nonprofit Council, please contact: Deborah Ballard, by at deborah.ballard@hhsc.state.tx.us This agency is an equal opportunity employer and provider. Page 4 of 4