Mental Health Advisory Committee Application

Name:

Address or PO Box:
 

City/State/Zip:

Home Phone:

Business Phone:

Email:

Occupation:

Please answer all of the following questions. You may attach additional pages if you need more room to answer.

1. What qualifications will you bring to the DLC Board?

2. What is your interest and motivation for serving as a Board member?

3. Please explain your knowledge of the issues affecting persons with disabilities.

4. Describe your experience in community organizations, including service on boards or advisory committees.

5. Discuss your experience and knowledge working with specific underserved communities (e.g., Asian/Pacific Islander, African American, Alaska Native, Spanish speaking, or rural communities).

6. Describe your experience advocating for people with disabilities, or others.

7. Discuss your leadership or policy development experience.

8. Are you a member of other disability or civil right organizations? If so, please identify those groups below.

The Disability Law Center of Alaska's Board values diversity. In order to assist the Board in selecting diverse Board members, please identify which of the following group(s) you belong to:

African American

Asian/Pacific Islander

Hispanic/Latino

Alaska Native

White

Multi-racial

Decline to State

Developmental Disability

Psychiatric Disability

Learning Disability

Sensory Disability

Physical Disability

Other Disability:

• Please Specify

No applicant will be granted or denied a seat on Disability Law Center of Alaska's Board of Directors based solely upon his/her response to these questions.

When you have completed the form, please:

• Attach any additional pages,
• Attach your resume,
• Attach references or endorsements from disability organizations that support your candidacy, and,
• Return this form and attachments.