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CentralinaArea Agency on Agi~g !'" Home ana Community Care Block Grant Process Form: 3 APPOINTrMENT OF ADVISORY COMMITTEE FO~ THE HOME AND COMMUNITY CARE BLOCK GRANT FOR OLDER ADULTS .In order,to implement the Home a~d Community Care Block Grant for Older Adults, the Board of County Commissioners must have appoint~d an Advisory Committee to assist the designated Lead Agency in the development of the County Aging ~unding Plan. This committee must be composed of potential public and private providers of aging services,! elected county officials, older adults and other aging interests in the county. Please complete the remainder of this form to indicate the appointment and membership of this committee. County Date of Board Action Cabarrus Mav 23. 2005 Board of Commissioners Chairperson Signature County Manager Slgneture f,?.d-dl. *f Sign re I I Lead Agency Representative (Check One) X An existing on-goirllg committee has responsibility for the Home and Community Block Grant. MembershiJi> consists of Board of Commissioner appointments made on a rotating basis. This commi~ee will maintain responsibility for the Home and Community Block Grant until further riotice. I Name of Committe~: HCCBG $teerina Committee Length of Terms of Office: two vears Committee Year Is: i Fiscal Year (Calendar Ve.r. Floca' Vear. or other) The Board of Co~missioners appoints a special commiitee each year to fulfill the responsibility for th~ Home and Community Block Grant Committee. .. /-/-3 I Complete and attach the Mem~ership List (Form 4) for the Committee assigned responsibility for the Home and $ommunlty Care Block Grant. Please mail thisformtoGaylaS.W~ody.Aging Program Administrator, Centralina Council of Governments, P. O. Box 35008, Charlotte, NC 28235J 05104 (blue)