Community Advisory Committee

To be eligible you must be a resident of Arkansas and be at least 18 years of age. Please check the boxes below to confirm. *

I live in Arkansas

I am age 18 or older

First Name *

Last Name *

Email Address *

Phone

Phone Access

Voice Only

Voice and Text

Text Only

Address Line 1 *

Address Line 2

City *

State

Zip Code *

Please state your interest in serving on the Partners Community Advisory Committee: *

Please explain what you think “inclusion” means when discussing individuals with disabilities. What does this mean to you? *

Please share any other particular qualifications or experiences with disability that you feel would benefit the Partners Community Advisory Committee: *

There are categories of membership on our Community Advisory Committee that are required by the Developmental Disabilities Act. Please identify the category or categories in which you qualify for membership: *

Individual with an Intellectual / Developmental Disability

Family member of an individual with an Intellectual / Developmental Disability

Representative of a state agency, local agency or nonprofit agency that serves individuals with Intellectual / Developmental Disabilities

We strive to include different experiences related to disability. For this purpose, we ask that you list the specific disability/disabilities of you or your family member. We will only use this information to insure broad-based representation when selecting Committee members. Organizational representatives should give a brief description of the types of disabilities covered by your services. *

Optional: We strive for diversity in representation. Responding to these questions on race/ethnicity may help us achieve that goal. You may check more than one box or choose not to respond. *

Phone

Captcha

What is the Partners Community Advisory Committee?

What is the Committee’s Purpose?

What are the Responsibilities of a Committee Member?

What Do I Do if I’m Interested in Serving?

Community Advisory Committee Consideration Form

Contact Us

Accessibility

Disclaimer & Policies