CFAC Membership Application

Thank you for your interest in joining the Vaya Health Consumer and Family Advisory Committee (CFAC). The CFAC represents and gives voice to people who receive services for mental health, substance use disorder, intellectual/developmental disabilities (I/DD), or traumatic brain injury (TBI) by providing important input into Vaya’s operations and processes.

A Vaya representative will contact you to follow up on your application. For help, email cfac@vayahealth.com or call 1-800-893-6246 and ask to speak with a CFAC liaison.

General Information

Name(Required)

Home Address(Required)

County of Residence(Required)

City(Required)

State(Required)

Zip Code(Required)

Primary Phone Number(Required)

Email Address(Required)

Demographic Information

Vaya strives to make sure CFAC members are representative of all people in our region. Please provide the following information about yourself.

Gender(Required)

Preferred Pronouns(Required)

Other race

Responsibilities

CFAC membership includes attending regular meetings and occasional subcommittee meetings. Meetings are held in a hybrid format, with the option to attend in person or virtually from your home computer, and generally last two to three hours. Upcoming meeting dates and times are available on our Calendar of Events.

No special knowledge or training is required to serve on the committee—just a desire to improve services in our local communities.

You selected yes, please describe the accommodation

Please include any other information you would like to share with the committee.(Required)

The Vaya Health Consumer and Family Advisory Committee (CFAC) will use the information provided in this application to select committee members based on North Carolina state requirements to maintain a committee representative of individuals and caregivers of individuals receiving mental health, substance use disorder, I/DD, and/or TBI services. Vaya and the Vaya CFAC will respect and protect the confidentiality of individuals applying for membership.