OFFFICAL APPOINTMENT FORM
Appointment to: NEW HORIZONS MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND
ADDICTIVE DISEASES COMMUNITY SERVICE BOARD
Number of Appointments:_____1_______for Muscogee County
Date: August 1, 2006 Prepared by: Jenn Green Telephone: (706)596-5583
Nominee/Appointee Address Gender Race/Ethic Group Occupation Consumer /
Family
Member/ Interested Citizen Disability Representation Check One for Consumer and
Family Only
MH DD AD
Sandra Gill
Term: 7/1/06-6/30/08
1059 Leaf Brook Drive
Midland, GA 31820-5502
F Hispanic Customer Service Representative Family Member X
Signature of County Commission/City Council
Chair:_________________________________________________________
Date
Approved:_______________________________________________________________________
________________
PLEASE RETURN SIGNED ORIGINAL DOCUMENT TO: MRS. JENNIFER GREEN, NEW HORIZONS
CSB, P.O. BOX 5328,
COLUMBUS, GA 31906-01328
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