Frederick County School Health Council

Your Name Your Name First Last
Your Address Your Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Your Telephone Number Your Telephone Number - ### - ### ####
Your Email Address
I am applying as a:

I am applying as a: Parent Community member
If you are applying as a parent, what school does your child(ren) attend?
If you are applying as a community member, who is your employer?
Briefly explain why you are interested in serving on the School Health Council:
Please list any previous professional or personal experiences that may be helpful to you as a committee member: