Board and Advisory Council Application - Disability Rights Washington

Name *

First Last

Pronouns *

Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone number

Email *

Employer and Title if applicable

For which of the volunteer position(s) are you applying (ok to check more than one) *

Board of Directors Member
Disability Advisory Council Member
Mental Health Advisory Council Member

Please tell us why you are interested in serving on Disability Rights Washington’s Board or Advisory Council. *

What in your background prepares you to contribute to a more diverse, equitable, inclusive, and just DRW? *

What are the top 3 skills and/or experiences you will bring to the organization? *

DRW is deeply committed to equity and justice work. Please tell us about a time where you’ve advocated for equity, inclusion, or justice. *

Demographic Data

Please note: providing this information is optional but highly encouraged. If you are accepted, DRW will use this information for anonymous federal reporting purposes. If you have any questions, please email daryaf@dr-wa.org.

Ethnicity (Select one)

Hispanic/Latino/Latinx
Non-Hispanic/Non-Latino/Non-Latinx

Race (Select all that apply)

American Indian or Alaska Native
Asian
Black/African American
Hispanic/Latino/Latinx
Native Hawaiian/Pacific Islander
Middle Eastern or North African
White
Two or more races
Other

If Two or More, or Other, list here:

Gender (Select one)

Female/Cis Female
Male/Cis Male
Non-Binary
Two Spirit
Transgender Female
Transgender Male
Prefer Not to Disclose
Other

Age (Select one)

21 or Younger
22-39
40-59
60-79
80+
Prefer Not to Disclose

Your Experience and Connection to Disability Rights Work

Please note: The BOD is made up of at least 60% people with disabilities and/or their family members. The DAC is exclusively made up of people with disabilities. The MHAC is made up of at least 60% current/former recipients of mental health services or their family members.

Select all options that apply: *

Are there other identities or communities you belong to that you would like to share? For example: LGBTQIA+, immigrant, religious, veteran, employment or economic situation, justice-involved, etc