OFFICIAL APPOINTMENT FORM
Appointment to: NEW HORIZONS MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND
ADDICTIVE DISEASES COMMUNITY SERVICE BOARD
Number of Appointments:_____1_______for Muscogee County
Date: June 4, 2010 Prepared by: Tiffany Sellers 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
Suzanne Goddard
Term: 7/1/10-6/30/13
637 First Avenue
Columbus, GA 31901
F White Lawyer Interested Citizen
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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