AWA Board of Director Application
Please provide answers to the following questions to be considered for the Arkansas Waiver Association Board of Directors.
City, State, Zip
Agency or Company (if applicable)
Date of Birth
Which category best describes you? (check all that apply)
American Indian or Alaska Native
Black or African American
Hispanic, Latinx or Spanish Origin
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
I prefer not to respond
How do you currently describe your gender identity?
Do you have a disability?
If yes, please specify disability:
Are you a parent or guardian of an individual with a disability?
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?
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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