AACPDM Community Council

Application for AACPDM Community Council

The AACPDM Community Council's primary purpose is to provide the voice of the variety of stakeholders (i.e. individuals with lived experience, parents, other non-profit representatives, etc.) to enhance the mission of the AACPDM with the goal of creating greater opportunities to collaborate for the health, wellness and service towards those with cerebral palsy and other childhood-onset disabilities.

Expectations of Voluntary Council Membership

Commitment to serve the full term indicated;
Regular participation in meetings and conference calls;
Contribution of ideas and working to complete tasks and charges;
Completion of assignments on schedule or in a timely manner;
Terms of service is three years, renewable for one additional term

Applications are reviewed in the late spring, but can be submitted year-round.

Please apply for the council by filling out the form below.
* indicates a required field

Applicant Information:

First Name:

Last Name:

Address:

City:

State/Province:

Zip:

Home Phone: (area code + number)

Cell Phone: (area code + number)

Work Phone: (area code + number)

Email:

Will you allow your contact information to be shared with other Community Council members? Yes No

AACPDM Affiliation:

I am/was: A Representative of a Nonprofit CP Organization – (Please List) An individual with CP or other childhood-onset disabilities A family member of someone with CP or other childhood-onset disabilities

We, at the AACPDM are looking for Community Council members who have a diversity of experience and interests and appreciate your sharing any information. Please be assured that this information is private and will be maintained as CONFIDENTIAL.

Tell us about your personal experience with CP and/or other Childhood Onset Disabilities. What would you have improved about this experience? What has impressed you about this experience? (1500 character limit)

Why would you like to serve on the AACPDM Community Council? (1500 character limit)

If you have served as an advisor or have previous leadership experience, been an active volunteer or done public speaking for another organization, please briefly describe this experience: (1500 character limit)

Is there anything additional you would like us to know? (1500 character limit)

Times when you are able to participate in the Community Council Conference Calls (Check all that apply) Daytime Evening Weekend

Do you have access to email and are you willing to correspond via email? Yes No

Are you willing and able to assume the responsibilities associated with being a Council member as described on the AACPDM website? Yes No

How did you learn about the Community Council?

AACPDM member Community Council Member Non-profit organization Other

Please provide the name and phone number or email address for one reference we can contact

Please upload a letter of recommendation

* By clicking the submit button you are also providing your electronic signature

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AACPDM Members

Application for AACPDM Community Council

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