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UPMC Community HealthChoices

Participant Advisory Committee Membership Application

UPMC Community HealthChoices (UPMC CHC) seeks UPMC CHC participants, family caregivers, direct care workers, and providers to join the UPMC CHC Participant Advisory Committee (PAC). The purpose of this participant-led forum is to provide guidance and support to UPMC CHC in its ongoing implementation of its program. Members of the committee will be diverse in age, ethnicity, gender, and disability, as well as representative of both urban and rural populations.

Space on the committee is limited. You may submit this form at any time; it will be kept on file if the committee is full. UPMC CHC will consider forms on file when openings on the PAC become available.

If your application is chosen, we will interview you before accepting you to the UPMC CHC PAC. Committee members should expect to serve one full year.

If you are interested in serving on the committee, please fill out this form.

* Indicates required fields

Please share why you are interested in serving on the UPMC CHC PAC (use another page if needed):*

Please list any of your qualifications or experiences that you feel would benefit the UPMC CHC PAC (use another page if needed):*

Please check the category that would best describe your role on the UPMC CHC PAC:*

I certify that all statements made in this application are true and complete to the best of my knowledge. I understand that any false statement, misrepresentation, or omission may result in my dismissal from the UPMC CHC Participant Advisory Committee.

If you have questions or need any language- or disability-related accommodations to complete this form, please email