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Council Member Application
In the space provided below, indicate why you are interested in serving on the council.
In the space provided below, what previous experience, areas of interest or skill areas do you have that would lead to logical work on committees? Examples of some NYSILC committees include Monitoring & Evaluation, Public Policy, Emergency Preparedness, Development, Finance, State Plan, Recruitment, Consumer Satisfaction and Needs Assessment.
In the space provided below, what affiliations do you have with other national, statewide, and regional groups, especially related to people with disabilities?
Please provide a name, relationship, phone number, and email of your Professional Reference
Please provide a name, relationship, phone number, and email of your Personal Reference
Please provide us with some background information about yourself:
Are you a person with a disability?
If yes, please identify your general disability type:
If selected other, please specify:
What is your gender/how do you identify?
What is your race/ethnicity?
American Indian/Alaskan Native/Indigenous Person
Native Hawaiian/Pacific Islander
Two or more races
If the designations are inadequate, please tell us your preferred identification below
What is your age within a selected range?
69 or Above
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