MO-CASE Committee Member Application
Interested in becoming more involved with our organization? MO-CASE is looking for interested individuals who would like to serve on available committees openings  or as ad hoc volunteers. Please complete the following interest form and someone from our organization will be in contact with you.  If you have any questions please feel free to reach out to our Executive Director, gayle.willey@mo-case.org
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Email *
DATE *
MM
/
DD
/
YYYY
NAME *
SCHOOL DISTRICT/EMPLOYER *
PROFESSIONAL POSITION *
PLEASE DESCRIBE YOUR LEADERSHIP ROLE IN YOUR CURRENT POSITION.  *
ADDRESS *
PHONE NUMBER *
CEC/CASE MEMBER NUMBER *
I'M INTERESTED IN THE FOLLOWING VOLUNTEER OPPORTUNITY:
-Committee member work requires participating in regularly scheduled online meetings  
-Ad Hoc volunteers are working with committee members on specific tasks that occur as needed
*
Required
IF INTERESTED IN COMMITEE WORK PLEASE INDICATE WHICH COMMITTEE YOU ARE INTERESTED IN (CHECK ALL THAT APPLY)
PROVIDE A SHORT LIST OF LEADERSHIP CONTACTS/REFERENCES (I.E. SUPERINTENDENT, OTHER AREA SPED DIRECTOR, CURRENT OR FORMER MO-CASE BOARD MEMBERS) *
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