Client Advisory Council Application
The Women’s Community Clinic is recruiting current and former clients
to join our Client Advisory Council. As someone who has shown an
interest and commitment to women’s health and to the Clinic, we would
like to invite you to apply to the Council.
The Client Advisory Council provides the Clinic with important
feedback on services and programs to ensure that we continue to meet
the needs of our clients and community.
Council members will also
have opportunities to develop leadership skills, in order to act as an
ambassador for the Clinic in the community. The Council will meet the
last Tuesday of every other month from 6pm-8pm. The next meeting is
Tuesday, September 23, 2014. Attendees will receive a $25 stipend for
full attendance.
If you are interested in applying, please answer the questions below
and return them via mail, fax, or email by Friday, September 5, 2014
to:
Dana Kleinhesselink, Community Engagement Coordinator
Women’s Community Clinic
1833 Fillmore Street, 3rd Floor
San Francisco, CA 94115
Fax: 415.379.7384
Email: dana@womenscommunityclinic.org
Feel free to call Dana, Community Engagement Coordinator, with any
questions: 415-820-7384.
Name:
Nickname (preferred name):
Address:
City, State, Zip Code:
Primary Ph. #:
Secondary Ph. #:
E-mail Address:
Date of Application:
1. Are you a current or former client?
Neither
Current
Former
2. Are you able to attend meetings the last Tuesday of every other
month from 6pm-8pm?
Y
N
3. The next meeting is scheduled for Tuesday, September 23, 2014 from
6pm-8pm. Can you attend that meeting?
Y
N
4. Do you feel comfortable working in a pro-choice organization?
N
Y
5. Please tell us, briefly, why you are interested in serving on the
Women's Community Clinic’s Client Advisory Council? (please feel
free to respond on a separate page)
Please return this application by mail, drop-off at Clinic, fax, or
email by September 5, 2014. Thank you!
Client Advisory
Committee
2014 Meeting Schedule
Date
Topic
Tuesday, January 28, 2014
Full-Scope Primary Care
Services at the Clinic
Tuesday, March 25, 2014
cancelled
Tuesday, May 27, 2014
Christine Dehlendorf & Team;
other
Tuesday, July 22, 2014
Christine Dehlendorf & Team;
other
Tuesday, September 23, 2014
TBD
Tuesday, November 25, 2014
Christine Dehlendorf & Team;
other
All meetings are from 6-8 pm in the A-level conference room.
Snacks and beverages provided.
Member Position Description
The Client Advisory Council (CAC) is comprised of clients of the
Women’s Community Clinic. The Council will provide the Clinic with
important feedback on services and programs to ensure that we continue
to meet the needs of our clients and community. Council members will
also have opportunities to develop leadership skills, in order to act
as an ambassador for the Clinic in the community. Primarily, the
Council prioritizes the following activities:


Constructive suggestions, feedback, and insights for the improvement
and maintenance of the Clinic’s services and programs
Reviewing health education materials and other communications
The Council will meet every other month from 6pm-8pm.
Meetings are typically held at 1833 Fillmore Street, Lower Level (or
Level “A”) Conference Room but may occasionally be held at alternate
pre-announced locations or times. The Client Advisory Council will be
led and supported by the Clinic's Project Manager, and other staff
attending as needed.
Membership Expectations
Each committee member shall:



Attend and participate in up to six meetings, with a minimum of
three meetings per year, not including possible meetings scheduled
for sub-committee work;
Offer essential skills and experience ;
Commit to playing a significant role in advising the Women’s
Community Clinic;






Maintain confidentiality of personal information of CAC members and
activities, as well as confidential information related to Clinic
activities;
Assist Clinic staff as needed with input on the CAC agenda, guest
speakers, snacks, etc.;
Prepare in advance for CAC meetings, as appropriate, by reading
assigned articles and/or gathering information on relevant
healthcare topics;
Commit to respecting other panel members who may have different
experiences, beliefs, concerns, and needs;
Competently represent the Clinic, its mission and belief, and its
clients and their needs to various audiences; and
Be able to participate in discussions between committee meetings via
email or phone.
Membership Terms





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Members shall commit to a one-year term (or six meetings), upon
accepting a seat on the Council, which can be renewed up to two
times for a maximum term of three years.
Members shall successfully complete an initial 3-month probationary
period on the CAC.
Members shall remain active clients of the Women’s Community Clinic,
as defined as being seen within one year of the current Council
meeting date. Members not seen at the clinic within one year of the
current meeting will roll off the Council within four months (may
attend up to 2 additional meetings).
If unable to attend any of the scheduled meetings, Council members
will contact the Project Coordinator in advance.
Members agree to keep the Women’s Community Clinic informed of any
changes to their phone and/or email contact information, so they may
receive scheduling and any other meeting reminders in a timely
fashion.
Members will receive a $25 stipend per meeting, for full and timely
attendance of each meeting. It is important to arrive on time to
meetings and participate fully. When unable to attend full CAC
meetings, members are encouraged to attend partial meetings. If
members arrive 15-20 minutes late, they will be paid a $10 stipend
(instead of the $25 stipend for full meeting participation). If
members arrive more than 30 minutes late to CAC meetings, they will
not be paid a stipend (instead of the $25 stipend for full meeting
participation).
I have reviewed, understand, and agree to follow this CAC Member
Position Description, and I have received a copy of this document.
Print Name
Signature
Date
Disciplinary Guidelines
As a member of the Women’s Community Clinic’s Client Advisory Council
(CAC),
I understand that the first 3 months of my CAC service are a
probationary period.
I understand that I will be immediately removed from the CAC for the
following:



Repeating confidential information about another CAC member
Violent or threatening behavior
Stealing from the Clinic or another CAC member
I understand that the following steps will be taken for other
inappropriate behavior:



First offense: Verbal warning
Second offense: Written warning
Third offense: Removal from the CAC
I understand that I can appeal these disciplinary steps, by asking the
CAC Project Manager or the Clinic Director.
Print Name
Signature
Date