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Council Application
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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)
Female
Male
Other
If other, please explain
Preferred pronouns
(Required)
He/Him/His
She/Her/Hers
They/Them/Their
I am
(Required)
African American
Asian
Caucasian
Hispanic
Native American
Other
If other, please explain
Application Details
I am applying for
(Required)
The first time
Reappointment
The position I qualify for is
(Required)
A person with a developmental disability
A parent of a child with a developmental disability
An immediate relative, parent, or guardian of a person with a developmental disability who is or was in an Institution
A person with a developmental disability who currently is or was in an Institution
A local non-governmental agency representative
A private nonprofit organization representative
The Protection and Advocacy organization representative
An University Center for Excellence in Developmental Disability representative
A state agency representative
Other
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)
Extremely High
High
Average
Low
My commitment level for working on other issues affecting people with developmental disabilities is:
(Required)
Extremely High
High
Average
Low
My comfort level for speaking in and before groups and making presentations is:
Extremely High
High
Average
Low
My comfort level for presenting information to state and local elected officials is:
Extremely High
High
Average
Low
Do you have commitments or conflicts that might prevent you from attending quarterly Council meetings in Boise?
Yes
No
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
Email
Phone
Relationship
First and Last Name
Email
Phone
Relationship
First and Last Name
Email
Phone
Relationship
Name
This field is for validation purposes and should be left unchanged.
ver: 3.5.2 | last updated:
November 4, 2022 at 09:30 am