Application for Membership in the Disability Rights Florida PAIMI Advisory Council

How did you hear about the PAIMI Advisory Council?

Check the categories for which you qualify for the PAIMI Advisory Council:

Parent of a minor child (under 18 years of age) who is receiving or has received public mental health services Attorney Mental Health professional (i.e., psychiatrist, clinical psychologist, clinical social worker, psychiatric nurse, mental health counselor, professional counselor and/or other position where you have received a bachelor or advanced degree to provide mental health professional services) Individual from the public who is knowledgeable about mental illness Mental Health service provider (i.e., peer advocate, support liaison and/or other position where you received training to provide mental health services) Individual who has received, or is receiving, mental health services Family member of an individual who has received, or is receiving, mental health services

Please describe any current or past experience you have had working or volunteering with community organization, including service on boards or advisory committees. Please identify all organizations and their locations.

What is your interest and motivation for serving as a PAIMI Advisory Council member?

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