Local Health Officer Contact Information Update

Please complete the form below if your contact has changed. Complete all sections that apply. Maine CDC will not update your information if there is missing information. Click Submit form button to send the new information to the Maine CDC. If you are required to submit your Letter of Appointment, E-Mail to: judy.gopaul@maine.gov or by U.S. Mail to Maine CDC, State LHO Program Coordinator, 286 Water Street, 8th Floor, SHS 11 Augusta, Maine 04333. Thank you!

Town's official letter of your appointment: Did your town issue an official letter of your appointment?:

If No, then (mm/yyyy):
If Yes, please send a copy of your signed letter of appointment either by email to: judy.gopaul@maine.gov or by U.S. Mail to: Division of Local Public Health, Maine Center for Disease Control & Prevention 286 Water Street, 7th Floor, SHS 11, Augusta, Maine 04333. You may also fax your letter to Judy Gopaul at 207-287-5355. This office will only issue a Certificate of Completion upon receipt of your letter of appointment.
On-line Training: Have you completed the LHO mandatory on-line self-paced training?


State Employee: Are you a state employee?:
Other Roles: Are you employed by your town government in another role (other than the LHO)?:

 

Maine CDC must receive your town's Letter of Appointment within 10 working days from the date of your appointment.

If you have not completed the Online LHO Core Training, you have 6 months from the date of appointment to complete the training.

    

Problems?

If you have any problems using this form, or do not receive a confirmation e-mail, contact Judy Gopaul