UCR Disability Network Interest Form

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Please fill out this form if you would like to join the Disability Network and stay informed about upcoming events. If you have any questions, please email us at Sarah.McBride@ucr.edu & Michelle.Raheja@ucr.edu

Full Name *

UCR Email *

UCR affiliation *

Staff

Postdoctoral researcher

Faculty

Graduate student employee

Other:

Please select how you identify yourself: *

Person with a disability

An ally for people with disabilities

Do not wish to answer

Other:

Please tell us briefly why you are interested in joining the Disability Network. *

Would you be interested in getting involved in the following? *

Event & Community Committee

Advocacy Committee

Marketing Committee

Chair or Co-Chair

Leadership Roles

Attending events as a participant

Other:

Required

What kind of events or activities would you like to see the Disability Network organize or offer?

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