Board of Commissioners

Thomas M. Herek, Chair
Michael J. Duranczyk, Vice Chair
Vaughn Begick, Sergeant at Arms

Bay County Building
515 Center Avenue, Suite 405
Bay City, Michigan 48708-5125
Voice: (989) 895-4120
Fax: (989) 895-4226
TDD/TTL: (989) 895-4049

Application for Appointment to Bay-Arenac Behavioral Health Authority (BABHA)

 

Name:
Address:
City, State, Zip Code:
Home Phone:
Business Phone:
Occupation:
Employer:
Are you a resident of Bay County?
How Long?
List your interests and qualifications for the above Board or Commission:
 
List any other information you feel would be pertinent in assisting the County Board of Commissioners in their selection
 
What is your e-mail address?
 

Bay-Arenac Behavioral Health Authority (BABHA)
Board Member Application Questionnaire

 

 According to the Mental Health Code (1995, PA 290 MCL 330.1222) certain requirements and limitations are
imposed on the composition of the community mental health board membership. Please respond to the
following questions:

 

YES

NO

 
1)   I am 18 years of age or older (must be 18+)
2)   I am a county commissioner (limit of 4 commissioners)
3)   I am a state, county or lcal public official (limit of 6 officials serving in an elected or appointed public office or employed more than 20 hours/week by an agency of federal, state, city or local government)
4)   I live in Bay County (must have primary residence in Bay County)
5)   I am employed by the Michigan Department of Community Health
6)   I am employed by BABHA
7)   I am a party to a contract with community mental health or administering or benefitting financially from a contract with BABHA
8)   I serve in a policy-making position with an agency under contract with BABHA (If you checked yes to 5, 6, 7 or 8 you cannot be appointed to the BABHA Board)
9)   I am/have been a primary consumer of mental health services. (primary consumer means an individual who has received or is receiving service from the Department of Community Health or a community mental health services program or services from the private sector equivalent to those offered by the Department of Community Health or community mental health services program. This means just about any mental health service you have ever received in your entire lifetime).
10)   I am/have been a family member of a primary consumer (Family member means parent, step-parent, spouse, sibling, child or grandparent of a primary consumer or an individual upon whom a primary consumer is dependent for at least 50% of his or her financial support. Same service and timeframe criteria as primary consumer).        
           
For items 9 and 10, 1/3 of the BABHA Board (4 members) must be primary consumers or family members and of that 1/3 at least 1/2 (2 members) shall be primary consumers.
11)   I can be identified as a primary consumer and hereby grant permission to the BABHA Board to identify me as such when asked to do so. I waive only those rights under the Mental Health Code that are necessary to make this identification.
12)   I can be identified as a family member of a primary consumer and hereby grant permission to the BABHA Board to identify me as such when asked to do so.

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