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PAIMI Council Application
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PAIMI Council Application
Tell us about yourself.
Name
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First
Last
Address
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Street Address
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Reason you are applying.
List groups/organizations that you are a member of and identify your role or accomplishments in the group(s).
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What opportunities have you had to help improve disability-related services?
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. Why do you want to serve on the dLCV PAIMI Advisory Council?
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If you have other skills, talents, experience or education you feel would help the Councils in their activities, please share that here.
Please check all that apply.
Recipients/Former recipients of mental health services
Family member of recipients/former recipients of mental health services
Family member of a minor child or youth (under 18 years old) who has received or is receiving mental health services
Mental health service provider
Mental health professional
Attorney
Individual knowledgeable about mental illness
Currently, the Council meets four to five times a year usually in Richmond. In addition, Council members may be asked to serve on Committees appointed by the dLCV Governing Board. Will you be able to commit to attending the meetings?
Yes
No
By submitting this application, you understand and approve that the information in the application will be shared with the PAIMI Advisory Council in consideration of nomination to the PAIMI Advisory Council.
I agree to volunteer for the disAbility Law Center of Virginia (dLCV) with no compensation. I also agree to comply with dLCV’s policies and honor the confidentiality of information about individuals and families who are served by dLCV.
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Yes, I agree to the above terms and conditions.
Thank you for taking the time to complete our application. We sincerely value your input. Please click the "submit" button below.
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