AWA Board of Director Application
Please provide answers to the following questions to be considered for the Arkansas Waiver Association Board of Directors.
Email address *
Name *
Address *
City, State, Zip *
Home Phone
Cell Phone
Occupation
Agency or Company (if applicable)
Date of Birth
MM
/
DD
/
YYYY
Which category best describes you? (check all that apply)
How do you currently describe your gender identity?
Do you have a disability?
Clear selection
If yes, please specify disability:
Are you a parent or guardian of an individual with a disability?
Clear selection
If yes, please specify disability and age of the person with a disability:
What experience have you had with community-based support services for individuals with disabilities?
What experience have you had serving on boards or committees?
Would you commit to attend quarterly board meetings of approximately three hours and provide additional support to committees and projects as needed?
Clear selection
What is your major interest in serving as an Arkansas Waiver Association board member?
Why do you think you are a good candidate for this board?
A copy of your responses will be emailed to the address you provided.
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