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Centralina Area AgenCy on Aging Home and Community Care Block Grant Process Form: 3 <br /> <br />APPOINTMENT OF ADVISORY COMMITTEE FOR THE <br />HOME AND COMMUNITY CARE BLOCK GRANT FOR <br />OLDER ADULTS <br /> <br />In order to implement the Home and Community Care Block Grant for Older Adults, the Board of County <br />Commissioners must have appointed an Advisory Committee to assist the designated Lead Agency in the <br />development of the County Aging Funding Plan. This committee must be composed of potential public and <br />private providers of aging services, elected county officials, older adults and other aging interests in the county. <br /> <br />Please complete the remainder of this form to indicate the appointment and membership of this committee. <br /> County <br /> <br /> Date of Board Action <br /> <br /> Board of Commissioners Chairperson <br /> County Manager <br /> <br /> Lead Agency Representative <br />(Check One) <br /> <br />Signature <br />Signature <br />Signature <br /> <br />An existing on-going committee has responsibility for the Home and Community Block <br />Grant. Membership consists of Board of Commissioner appointments made on a rotating <br />basis. This committee will maintain responsibility for the Home and Community Block <br />Grant until further notice. <br /> <br />Name of Committee: <br /> <br />Length of Terms of Office: <br /> <br />Committee Year Is: <br /> <br />(Calendar Year, Fiscal Year, or other) <br /> <br />The. Board of Commissioners appoints a special committee each year to fulfill the <br />responsibility for the Home and Community Block Grant Committee. <br /> <br />Complete and attach the Membership List (Form 4) for the Committee assigned responsibility <br /> for the Home and Community Care Block Grant. <br /> <br />Please mail this form to Gayla S. Woody, Aging Program Administrator, Centralina Council of Governments, P. <br />O. Box 35008, Charlotte, NC 28235. <br /> <br /> <br />