Form Center

2. The Health and Human Relations Commission was established to support the promotion and development of a community which functions as one with equality and dignity for each citizen of Jefferson County; and, to promote public health, welfare, security, positive human relations, respect, and the integrity of every individual.
4. Name*
5. Phone(s)- Please list a number that you can receive text messages*
7. Address*
8. Email Address*
10. Do you reside in Jefferson County?*

    1. Yes
    2. No
14. Tell us about yourself
16. Why do you want to join the Jefferson County HHRC?
18. Currently, the Health and Human Relations Commission meets monthly, on the last Thursday of the month at 6:00pm. Would you be able to meet regularly at this time, if appointed to this Commission?
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field