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Tarrant County HIV Planning Council Application

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If you are passionate about making a positive impact and have real-life experience or a background that you believe will offer a beneficial perspective to the North Central Texas HIV Planning Council (NCTHPC), consider applying today.

Individuals seeking to serve need not have prior service on an HIV Planning Council, but applicants who possess strong interpersonal, administrative, and problem-solving skills will help contribute to successful and effective Planning Council outcomes. Information collected will be reviewed by parties who are required to consider applicants for Planning Council appointment and will not be otherwise shared or distributed.

Note: It is a legislative requirement and programmatic expectation that the Planning Council include members of various membership categories and composition to reflect community demographics. As such, many applicants who apply might not be placed on the Planning Council for service. Any submission for consideration is greatly appreciated and valued.

  1. Section 1 - Contact Information
  2. Section 2 - Demographic Information
  3. Section 3 - Personal Information
  4. Section 4 - Declaration of Conflict of Interest
  5. Section 5 - Questionnaire
  6. Submission

Please be aware that the Planning Council is a public body. While your HIV status and contact information will be kept confidential, membership on the Planning Council is not. You will receive emails regarding Planning Council business and your physical address is necessary for official letters and notifications. Phone contact will be used only as a backup or upon request.

Planning Council Conflict of Interest Statement

  • Members of the Planning Council who serve any Ryan White Part A sub-recipient or potential sub- recipient as a member of a fiduciary board, who are employed by a Ryan White Part A sub-recipient or potential sub-recipient, or who have any other affiliation with a Ryan White Part A sub-recipient or potential sub-recipient are considered affiliated. 

  • Affiliated Planning Council members may participate in the priority setting or resource allocation process but must abstain in the category in which they hold a conflict. 

  • This includes reallocation of funds. 

  • Planning Council members must disclose any actual or perceived conflict of interest, in writing, on a form that is maintained in the office of the Planning Council. 

  • In most instances, conflict of interest does not refer to a person living with HIV disease whose sole relationship to a funded provider or potential provider is as a person receiving services. 

  • Planning Council members in breach of conflict-of-interest policy may be asked to resign their position or be removed from the Planning Council.

Please answer the following questions, describing your experience and what you would like to accomplish as a member of the Planning Council (attach another sheet if necessary)

Please reach out to us if you have any questions regarding the application:

dmstepney@tarrantcountytx.gov OR gmlewis3@tarrantcountytx.gov

817-321-4742      817-370-4549

We are located at:

North Central Texas HIV Planning Council

2300 Circle Drive, Suite 2306 Fort Worth, TX 76119

Please be aware that some or all of the information that you submit using this form is subject to public disclosure under the Texas Public Information Act. For an overview of this act, visit the Texas Attorney General's website.

Please note that Tarrant County employees are prohibited by law from providing legal advice. If you need legal assistance, call the Tarrant County Bar Association at 817-336-4101 or visit the Tarrant County Bar Association website.

This page was last modified on August 10, 2023