Disability Rights Florida PAIMI Advisory Council Application

Please check which of the following apply to you (check all that apply):

AttorneyMental health professionalProvider of mental health servicesIndividual who has received, or is receiving, mental health services Family member of an individual who has received, or is receiving, mental health servicesIndividual who is knowledgeable about mental illnessParent of a minor child (under 18 years of age) who has received, or is receiving, mental health services

Of the above categories checked, please specify what you consider to be your primary category (choose one):

AttorneyMental health professionalProvider of mental health servicesIndividual who has received, or is receiving, mental health services Family member of an individual who has received, or is receiving, mental health servicesIndividual who is knowledgeable about mental illnessParent of a minor child (under 18 years of age) who has received, or is receiving, mental health services

List practical and/or personal experience with the mental health system that you have:

What is your current occupation/employer?

List volunteer positions/experience:

Are you currently a board member of any organization(s)?

NoYes - please list below

With which organizations are you currently a board member?

Why do you want to serve on the Florida PAIMI Advisory Council

What skills, talents, experiences or education do you have that would help the Council in their activities?

Regular PAIMI Advisory Council (PAC) meetings take place on a quarterly basis (4 times per year), with occasional special meetings when needed. Meetings are generally held during regular business hours, between 8:00am-5:00pm, Monday through Friday. Most meetings are conducted remotely (through a computer or a phone), but some meetings may require in-person attendance. Standard travel expenses will be covered by Disability Rights Florida for in-person attendance at meetings.

Would you be able to participate in PAC meetings in person, virtually, or both?

In PersonVirtuallyBoth In Person and Virtually

Optional: If you would like to contribute any additional information please attach it here.