Application for PAIMI Council Membership
If you are interested in joining the Advocacy Center of Louisiana's Protection & Advocacy for Individuals with Mental Illness (PAIMI) Advisory Council, please complete the online application form below.
Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Telephone Number *
Your answer
Email Address *
Your answer
Ethnicity *
Your answer
Gender *
Are you a person with a mental illness? *
If you answered yes, please explain.
Your answer
Are you a family member of a person with mental illness? *
If you answered yes, please explain.
Your answer
Are you the parent of a child with mental illness? *
If you answered yes, please explain.
Your answer
Are you a mental health professional? *
Are you a mental health services provider? *
Are you an attorney? *
Are you knowledgeable about mental illness? *
Why are you interested in joining the PAIMI Council? *
Your answer
What do you think are the most important issues facing people with mental illness in Louisiana? *
Your answer
Are you committed to attending all Council meetings, which are held quarterly on Saturdays in locations across the state? The Advocacy Center will provide reimbursement for meeting-related travel expenses. *
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