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CIC Committee Interest Form

If interested in any of the Community Interfaith Coordination Commitees, please provide the following information and we will contact you.


In which committee(s) are you Interested?
Select all that apply.
Community Understanding and Respect     Emergency Preparedness
Prevention for Youth     Older Adult Ministries
Domestic Violence Prevention      Housing
Health      Mental Health

(There are currently no committees for Health and Mental Health, but we are taking note of the interest.)
Please provide a contact email address:

(Please enter your email address carefully to ensure a response.)

Contact phone number:

  (day)      (cell)

House of Worship or Organization:

Religion/Denomination of House of Worship

Additional Comment:

* Required Fields


NOTE: Any e-mail or other correspondence sent is considered a public record, and such records are subject to the Virginia Freedom of Information Act. This means that Virginia law generally requires the county to provide a copy of any such e-mail, upon request, for inspection and copying to any citizen of the commonwealth or to any member of the news media.

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Technical Questions: Web Administrator

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