Child note) Officials Child Professions School Group Fragile Education Services Nurse Counselor Age Health Administrator School Teacher High Health Services Teacher professionals Service (please School Group Representative Health Medically Middle Mental Other Other Government Other High Dentistry Religious Human Health School Special PTA Physician Public Youth School School School Business Food Junior Member’s Name & Role Parent Student Health Community Education Other GRID Ex: John co-chair X X MEMBERSHIP \
MEMBERSHIP GRID School Age Child Medically Fragile Child Special Education PTA Representative Middle School Junior High School High School Physician Dentistry Mental Health Public Health Health Professions Group Religious Group Human Services Youth Services School Nurse Health Teacher Other Teacher School Administrator School Counselor Food Service Other (please note) Business Government Officials Other professionals Member’s Name & Role Parent Student Health Community Education Other Ex: John co-chair X X \
Sample_SHAC_Forms.docx