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Step One

Starting January 2021, the Community Advisory Board will oversee the community funding awards generated from Community Outreach agreements for Holistic Industries and Alternative Rx. Funding is $25,000 per year, per company with an additional 1% of net profits once the businesses become operational.
The Mission of this Board is to objectively make funding awards based on 1) available funding 2) the company’s original licensing application community outreach goals 3) the City’s strategic plan. Projects that generate the largest community benefit while aligning with both the company’s original licensing application and the City’s current year strategic plan will be given the highest priority for funding.
As determined by the Community Outreach Agreements membership on the CAB is granted to the City of Madison Heights City Manager, Finance Director and two (2) City Residents. Resident members should check with their employer for any conflict of interest prior to volunteering to serve on the CAB Board for cannabis companies.
Name
Address
Phone Number
Email Address
Years Living In Madison Heights
Employer
Have you had experience with grant management/review in the past?
What skills/qualification/interest do you bring to the CAB:
Have you ever been arrested and convicted of a misdemeanor or felony*
Thank you for your interest in serving on the Community Advisory Boards. This application will be kept on file for ONE YEAR. All information in this application is public information and subject to disclosure in response to public records request made pursuant to the Freedom of Information Act.
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Step Two

The applicants will need to have a background check prior to being appointed to the Community Advisory Board.
In order to conduct accurate background checks at any time while applying for or while serving on a Board and/or a Commission, the applicant must provide their Race and Gender. The City of Madison Heights fully supports and complies with the laws which are enacted to protect and safeguard the rights and opportunities of all people, without being subjected or exposed to harassment or discrimination of any kind, including age, national origin, sex, race, religious affiliation, color, height, weight, or marital status.
I herewith release, defend and hold harmless the City of Madison Heights from any and all claims by myself which may arise from performance of the duties for which I am volunteering. I understand that the City of Madison Heights will indemnify me from any and all claims arising from the performance of the duties for which I am volunteering as long as I am following the rules, regulations, and policies of the department and the City.
I authorize the City of Madison Heights to investigate my background as determined necessary for the particular activity for which I am volunteering. I hereby release and discharge the City of Madison Heights, the Oakland County Sheriff’s Department, and/or the Michigan State Police and their agents from liability for any damage of whatever kind or nature, except for willful or intentional acts, that may result from release of this information to the City of Madison Heights.
Last Name
First Name
Date of Birth
Race
Gender
Signature
Date
Date
Date
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.*

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Community Advisory Board

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Step Two