Ikomidi elicebisa ukuthuthukiswa kohlelo lwe-5

Igama*

Okokuqala Last

Ikheli*

Ikheli lesitaladi Umugqa Wekheli 2 imizwa State Ikhodi ye-ZIP

County*

imeyili*

Hambayo*

Izindlela nokuhlangenwe nakho*

Kudingeka ukuthi uhulumeni abe nemibono ehlukahlukene kanye nokuhlangenwe nakho okumelelwe kule komiti. Sicela uhlole konke okusebenza kuwe:

Umqashi wamanje / Umsebenzi*

Kungani ufuna ukuhlanganyela kwi-Regional PIAC?*

Iziphi izinkinga zokunakekela impilo ezibalulekile kuwe futhi ngani?*

Ngumuphi amakhono, isipiliyoni, nombono ozizwa ungabelana ngazo?*

Uma uyilungu, ilungu lomndeni kanye / noma umnakekeli, uzizwa kanjani ukuthi umele ukwehluka kobulungu be-Health First Colorado? (Uma lokhu kungasebenzi kuwe, sicela ubhale okuthi "akusebenzi")*

Uzwile kanjani ngalesi sifunda seKomidi Lokululeka Ngezinhlelo Zokuthuthukiswa (PIAC)?*

Ulwazi Lwezibalo

Impendulo kulokhu okulandelayo iyakhethwa, kodwa iyakhuthazwa. Lolu lwazi luzocatshangelwa uma sikhetha amalungu ekomidi ngomzamo omuhle wokukholwa ukuba abe nokumelela okulinganayo kuzo zonke izindawo zabantu.

Ubulili

Ubuzwe

Certification*

Ngiyaqinisekisa ukuthi amaqiniso aqukethwe kulolu hlelo lokusebenza alungile futhi alungele konke okusemandleni ami. Ngiyaqonda ukuthi i-Colorado Open Records Act ingadinga ukuthi ulwazi oluthe xaxa oluqukethwe kulolu hlelo lube khona ukuze luhlolwe umphakathi jikelele. Qinisekisa ngokuhlola ibhokisi elingezansi:

Yebo

Ikomidi elicebisa ukuthuthukiswa kohlelo lwe-5

Idolobha nesifunda sase-Denver

Isifunda 5 PIAC