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HomeMy WebLinkAbout10.29.19 Email from Ashley Snyder - Behavioral Health Board Application - Horst County of Butte APPLICATION FOR APPOINTMENT TO BOARDS, COMMITTEES, OR COMMISSIONS INSTRUCTIONS: Please complete this form in its entirety. Be sure to include the full title of the Board, Committee or Commission for which you request consideration. *Please note that this application is a public document and is subject to the California Public Records Act (CA Gov. Code §6250-6270). Behavioral Health Advisory Board Board, Committee or Commission you wish to be appointed to: Seat Name (if applicable): District 3 Horst KyleC NAME: (Last) (First) (Middle/Initial) 95926 CA 845 Lynn Ln. Chico ADDRESS: (Street) (State) (Zip Code) (City) MAILING ADDRESS (if different from Home address): (530)898-5368 (714)335-2374 HOME PHONE: WORK PHONE: OTHER: khorst@csuchico.edu EMAIL ADDRESS: Professor of Psychology OCCUPATION: EDUCATION: Check appropriate box: High School Diploma GED/ CA High School Proficiency Certificate College Name of College/University Course of Study/MajorDegree Awarded BFA Chapman U.Creative Writing Chapman U. Psychology/MFTMA Kansas State U. Marriage and Family Therapy PhD Please provide any additional college/university/schools/training completed on a separate page. EXPERIENCE: Other County Boards, Committees or Commissions on which you have served: I serve on the CSU, Chico Academic Senate as an at-large senator. I serve as the treasurer for the California Interest Network of the American Association for Marriage and Family Therapy. 1 | Page Butte County Application For Appointment To Board, Committee, Or Commission EXPERIENCE continued: Additional applicable community experience and affiliations: Other experience you feel would be helpful to the Board of Supervisors in making this appointment: In addition to being a faculty member in the department of psychology, I am coordinator of the MFT program at CSU, Chico. We are the primary public training institution for MFTs in the North State. Many of our graduates take positions at the county and other CBOs. I am a Licensed MFT in the state of CA with a small private practice. REFERENCES: Please provide three (3) references with telephone numbers Linda Kline, PhD530-898-5147 1. Peter Lopez, PhD530-898-5292 2. 530-898-6171 Eddie Vela, PhD 3. *Members of boards, commissions, and committees may be required to: 1) file a Statement of Economic Interest Form also known as a Form 700, and 2) complete the State Ethics Training Course as required by AB 1234. *Members may be required to take the following training: 1) The Brown Act, 2) The Better Government Ordinance, and 3) Ethics Training. *You may submit a résumé, letter of interest, and/or additional materials with this application. *If you have any questions concerning the application process, a letter of interest or a specific appointment, you may contact the Clerk of the Board at 530-552-3300. Submit the completed application to the Clerk of the Board of Supervisors, 25 County Center Drive, Suite 200, Oroville CA 95965, or via e-mail at clerkoftheboard@buttecounty.net. 2 | Page Butte County Application For Appointment To Board, Committee, Or Commission