Donate
PAIMI Council Application
Home
/
PAIMI Council Application
Tell us about yourself.
Name
*
Required
First
Last
Address
*
Required
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Daytime Telephone
*
Required
Evening Telephone
*
Required
Email
*
Required
Reason you are applying.
List groups/organizations that you are a member of and identify your role or accomplishments in the group(s).
*
Required
What opportunities have you had to help improve disability-related services?
*
Required
. Why do you want to serve on the dLCV PAIMI Advisory Council?
*
Required
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.
*
Required
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.
Enter keyword
To find available resources, please enter a keyword.
Search
Try Searching For:
Special Education
Social Security
Supported Decision Making
Client Assistance Program (CAP)
Podcast
Voting Rights
×
