LTSS MAC Membership Application

Thank you for your interest in joining the Vaya Partners Long-Term Services and Supports (LTSS) Member Advisory Committee. Vaya Partners will maintain applicant confidentiality in accordance with federal and state law.

If you have questions about the committee or this application, please contact Vaya Partners’ Member Engagement Team at memberengagement@vayapartners.org or call 1-800-893-6246, ext. 4401.

General Information

Membership Requirements:(Required)
The LTSS Member Advisory Committee is required to reflect the LTSS populations (or their representatives) served by Vaya Partners and includes up to five committee members in each of the following categories. Please check the category or categories that describe you.
If you are an LTSS provider, care manager, or Vaya Partners staff member, provide your organization name and job title.

Demographic Information

County Represented(Required)
Please select one option.
Race/Ethnicity
Check all options that apply.

Additional Information

I am willing to have my name placed on the LTSS Member Advisory Committee member list.(Required)
Responsibilities: Membership on the LTSS Member Advisory Committee requires a moderate level of commitment of time and energy. Participation involves attending quarterly meetings and occasional subcommittee meetings. No special knowledge or training is required to serve on the committee, just a desire to improve the system. Additional reading on topics related to LTSS is required. Vaya Partners will provide this material.
I am committed to partnering with Vaya Partners to ensure high-quality services for all Vaya Partners members who use LTSS.(Required)
I am committed to attending quarterly LTSS Member Advisory Committee meetings lasting two to three hours.(Required)
I am committed to reading materials that are provided.(Required)
If applicable, I understand that my participation in public activities of the LTSS Member Advisory Committee may identify me as a Vaya Partners member or a relative of a Vaya Partners member who uses LTSS.(Required)

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