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Jackson County Community Children's Service Fund Board

  1. NOTE: To submit this form you do not have to sign in or create a Jackson County Form Center account above. However, you will have to complete the form in its entirety without the option to save your progress unless you do create an account.

  2. On November 8, 2016, Jackson County voters authorized the creation of the Children’s Services Fund of Jackson County. A diverse board appointed by the county executive will oversee the use of this fund to support agencies providing services for at-risk children and youth, from birth to age 19, in Jackson County. These services include temporary shelter for abused, neglected, runaway, homeless or emotionally disturbed children and youth; outpatient chemical dependency and psychiatric treatment; crisis intervention services; and prevention programs that promote healthy lifestyles among children and youth. The board's nine members shall be residents of Jackson County, serving staggered three-year terms, with at least one member residing in each of the six county legislative districts.

  3. Graduated*

  4. Graduated

  5. Graduated

  6. PDF and Word Doc. accepted

  7. Could you or your family be affected financially by decisions made by this board?

  8. Do you or your employer currently receive any other grant funds from Jackson County or any city within the county?

  9. Have you been a registered lobbyist or have you employed a lobbyist at any time during the past five years?

  10. If yes, did you receive any compensation?

  11. If board meetings are held during the day, will be able to come prepared and ready to actively participate?

  12. Have you ever been on active duty in the U.S. military?

  13. Gender

  14. Are you a U.S. citizen?*

  15. Are you registered to vote in Jackson County?*

  16. I will be able to provide documentation showing I do not have unpaid taxes in Jackson County.

  17. Leave This Blank:

  18. This field is not part of the form submission.