Historically Black Colleges and Universities (HBCU) Center for Excellence (CFE) Steering Committee Student Member Application

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1 Historically Black Colleges and Universities (HBCU) Center for Excellence (CFE) Steering Committee Student Member Application Thank you for your interest in serving on the HBCU-CFE Steering Committee. Your involvement in the Committee will provide an opportunity for you to enrich your academic experience, improve your leadership and team-building skills, and expand your professional network. The application packet consists of: 1. A description of the Committee 2. Application 3. Recommendation (Please provide the name and contact information of a faculty advisor/staff mentor that can provide a recommendation for you) 4. Reflection Questions (Please answer the two reflection questions). Your responses to the Reflection Questions will be evaluated and scored by the HBCU-CFE staff. The completed application packet is due Friday, August 28 th package to HBCU_CFE@msm.edu Applicants will be notified on or before September 18 th If you have questions regarding the process, please contact the HBCU-CFE Office via phone ( ) or (HBCU_CFE@msm.edu)

2 Background: Morehouse School of Medicine included in its Historically Black Colleges and Universities-Center for Excellence (HBCU-CFE) proposal a plan to establish a Steering Committee. As stated in the proposal, the Steering Committee would consist of six to eight members who would serve in an advisory capacity with participation in program planning and sustainability planning. Function and Responsibilities: Advise the HBCU-CFE Project Director and Co-Project Director on matters related to HBCU-CFE program activities Advise the HBCU-CFE on the needs of HBCUs as it relates to behavioral health workforce development, curricula development, campus services and behavioral health promotion Serve as an advocate and resource to the HBCU-CFE including identifying existing resources to assist the HBCU-CFE in serving the HBCU community Participate in information dissemination about activities of the HBCU-CFE Provide recommendations to the HBCU-CFE Project Director and Co-Project Director regarding future HBCU-CFE activities Participate in HBCU-CFE sustainability planning Procedures: The HBCU-CFE functions as a Cooperative Agreement with the Substance Abuse and Mental Health Services Administration (SAMHSA) with established goals, objectives and requirements outlined by the Request for Application (RFA) issued by SAMHSA prior to grant award. The HBCU-CFE Steering Committee is advisory in nature. Steering Committee recommendations are considered invaluable and will be formally shared with SAMHSA for SAMHSA s review and feedback. The HBCU-CFE will provide administrative support for minutes and agenda items for Steering Committee meetings. Meetings will occur quarterly via conference calls during the months of September, December and June. The annual face to face meeting may take place during the Dr. Lonnie E. Mitchell Behavioral Health Policy Academy. The exact date and time of meetings will be determined the LEM Planning Committee

3 Length of Term: Steering Committee Members will serve throughout the three year term of the grant from However, if a steering committee member is unable to complete a three year term or remains inactive for a period of 12 months, a replacement will be appointed by the Project Director. Steering Committee members will be recognized on the HBCU-CFE brochures and website. Travel: SAMHSA has agreed to provide support for the HBCU-CFE Steering Committee for face to face meetings. Compensation for requested travel will be made available. Correspondence: Steering Committee members may utilize the HBCU-CFE stationary for information dissemination regarding HBCU-CFE activities if needed. The HBCU-CFE would like to maintain copies of all correspondence sent on behalf of the HBCU-CFE as part of document retention. Special Call Meetings: Special Call meetings occur upon request of the Steering Committee Chair or HBCU- CFE Project Director. Additionally, SAMHSA may also invite Steering Committee members to attend and participate in special events at SAMHSA headquarters or other locations.

4 HBCU-CFE Steering Committee Member Application Contact Information Full Name: HBCU College/University Name: Mailing Address: Phone: Class Year (i.e., Junior): Major: Gender: Recommendation Information Please indicate the name of the faculty/advisor/staff mentor that can provide a recommendation: Name: Title: Phone: Home Town Address: Phone: Emergency Contact Name: Cell phone: Name: Cell Phone:

5 Reflection Questions Please answer the following questions with clear and thoughtful responses. 1) Describe highlights of your current leadership roles on campus and how you are collaboratively promoting behavioral health awareness on your campus community. 2) Why should you be selected to serve as a student member of the HBCU-CFE Steering Committee?