RAC Directory Application

The RAC Directory is a centralized resource designed to facilitate communication and collaboration among the members of the Regional Advisory Council (RAC). The goal is to create an accessible, user-friendly document that enables RAC members to connect with each other easily, whether for networking, project collaboration, or general council-related matters. The directory will serve as a valuable tool to strengthen the community, improve coordination, and enhance the overall impact of the RAC's initiatives.

This Directory will be available on our external resource guide - connecting your services to other like partners in Wayne County. While this guide is not published to the community at large, it will be available to those partners working with Wayne Metropolitan and the Regional Advisory Councils. Your participation will require the completion of this application and your explicit consent as indicated at the end of the form.

Consent for Inclusion in the RAC Directory

The Regional Advisory Council (RAC) Directory is a public resource to support networking and collaboration among RAC members. While it will not be actively promoted outside the agency, it will be publicly accessible. By providing your information, you consent to its inclusion and understand that other RAC members may contact you for collaboration or connection. You may request updates or removal at any time by contacting rac@waynemetro.org.

I consent to have my information included in the public RAC Directory.

YesNo

You Have Chosen Not to Be Included in the RAC Directory

Thank you for your response. Based on your selection, you will not be included in the RAC Directory, and your information will not be shared. If you change your mind in the future and wish to be added, please contact rac@waynemetro.org.

If you selected "No" by mistake, please restart the form and select "Yes" to provide your consent.

Directory Information

Are you participating as a:

Contact Information- Without Organization Affiliation

Name

Phone Number

Website?

Which RAC do you reside in or serve?

Organization Contact Information

Organization Name

Contact Person's Full Name

Phone Number

Organizational Website?

Which RAC do you reside in or serve?

Community Initiative Information

Please provide your Mission Statement:

Which community initiatives is your organization/work focused on?

Please list your program options here: Feel free to use bullets!

Who should be at the table? Please include name and contact information for a consumer, resident, or organization that can contribute or benefit from RAC membership?

Consent and Sign

Please sign below after reading the following information, otherwise this application will be considered incomplete.

Under penalties of perjury, I swear or affirm that this application has been examined by or read to me. If I am a third party applying on behalf of another person, I swear that this application has been examined by or read to the applicant. To the best of my knowledge, the facts are true and complete.

By signing below, I confirm that I have reviewed the information provided in this form and consent to the inclusion of my details in the public RAC Directory. I understand that this directory is publicly accessible (though not actively promoted outside the agency) and that RAC members may contact me for networking or collaboration. I also acknowledge that I can request updates or removal of my information at any time by contacting rac@waynemetro.org.

Yes

E-Signature

Contact Information