Membership Application

Council Application

Step 1 of 3

About Me

First and Last Name(Required)

If the name you go by is different than your first name, please give us your preferred name as well.

Phone

Email(Required)

Address(Required)

Street Address City ZIP / Postal Code

I identify as(Required)

If other, please explain

Preferred pronouns(Required)

I am(Required)

If other, please explain

Application Details

I am applying for(Required)

The first time

Reappointment

The position I qualify for is(Required)

If other or state agency, please explain

What qualifies you for the position you are applying for?(Required)

What are your specific disability-related interests or concerns?(Required)

What have you done to improve your concern?(Required)

As a Council member, in what ways will you help improve the lives of Idahoans with intellectual and developmental disabilities?(Required)

My commitment level for working on my disability related issues/concerns is:(Required)

My commitment level for working on other issues affecting people with developmental disabilities is:(Required)

My comfort level for speaking in and before groups and making presentations is:

My comfort level for presenting information to state and local elected officials is:

Do you have commitments or conflicts that might prevent you from attending quarterly Council meetings in Boise?

If yes, please explain:

Provide any other information that will help us to know you better.(Required)

References

Please list three (3) non-family references and their relationship to you. At least two of these references should be professional (employer, child’s teacher, civic leader, elected official, clergy, etc.).

First and Last Name

Phone

Relationship

First and Last Name

Phone

Relationship

First and Last Name

Phone

Relationship

This field is for validation purposes and should be left unchanged.