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.
Submit
Never submit passwords through Google Forms.
This form was created inside of Advocacy Center. Report Abuse - Terms of Service - Additional Terms