County of Santa Barbara by hd3hIc57


									                                           County of Santa Barbara
                             Department of Alcohol, Drug & Mental Health Services
                                  Mental Health Services Act / Prop 63

                     Capital Facilities/Technological Needs
                     MHSA Program and Expenditure Plan
                                     30-Day Public Comment Form
                                 December 14, 2009 – January 13, 2010

                                            PERSONAL INFORMATION

Name (Optional):


Telephone number(Optional):            E-mail (Optional):

Mailing address(Optional):

                                  My Role in the Mental Health System of Care

   Client/Consumer                                          Education
   Family Member                                            Public Health/Medicine
   Service Provider (not ADMHS)                             Social services
   ADMHS Staff                                              Faith-based community
   Law enforcement/justice system                           Other

Please offer your thoughts and comments below.*

A hard copy of this plan is available on request from Eric Baizer, 681-4744, ebaizer@co.santa-

If you need more space for your response, please feel free to submit additional information. After you
complete this questionnaire, you may return it in one of three ways:

       Print and fax to 681-5262 Attention: MHSA
       Mail to ADMHS/MHSA, 300 North San Antonio Road, Santa Barbara, CA 93110-1316
       E-mail it as an attachment to:

*If you prefer not to use this form, you are still welcome to send comments by fax, postal mail or e-mail in
any readable format.


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