Rural Institute for Inclusive Communities
Consumer Advisory Council

Application for Membership

The Rural Institute for Inclusive Communities at the University of Montana is seeking self-advocates, family members of individuals with disabilities, and professionals in the field, to serve as members on the Rural Institute Consumer Advisory Council (CAC). The members will help the Rural Institute review programs and develop strategies to best reach and serve individuals with disabilities, families, and professionals in Montana.

Members of the CAC are expected to:

Learn about Rural Institute projects
Attend council meetings four times per year (three meetings are online)
Serve on Council task forces and/or work groups as needed
Read, review and comment on Council-related materials
Share thoughts, ideas, and opinions about Rural Institute activities
Represent the Rural Institute Consumer Advisory Council at local, regional, and state events

The Rural Institute will support members to participate in CAC meetings by:

Reimbursing travel expenses for meetings
Providing an accessible meeting space, materials, and accommodations, as required, so all members can participate
Creating an environment that encourages everyone to practice leadership skills
Sharing information about the activities of our partners in Montana (and across the country)

More information about the Rural Institute and a current listing of our projects can be found on our website at http://www.ruralinstitute.org/. We believe that consumer leadership and guidance is essential to our work.

If you are interested in helping to improve the lives of individuals with disabilities by serving on the Rural Institute Consumer Advisory Council, please fill out this application and return it to us by e-mail, fax, or mail:

Rural Institute Consumer Advisory Council
Attention: Kim Brown

University of Montana

32 Campus Drive, 35 North Corbin Hall

Missoula, MT 59812
(406) 243-4852 (Voicemail)
brown@ruralinstitute.umt.edu

Name:

Address:

Home Telephone:

Cell Phone:

E-mail:

If you are employed, where do you work?

I am a:

Person with a developmental disability
Parent of family member with a development disability
Sibling of a family member with a developmental disability
Grandparent of a family member with a developmental disability
Other (Please explain in the next question)

Tell us more about your disability or your family member's disability:

Why are you interested in serving on the Rural Institute Consumer Advisory Council?

Do you have experience serving on a board, council, or other leadership experience?

How can you best participate in the CAC? For example, what days and times work best for meetings? What accommodations or training do you need? Do you need childcare or a support person to attend?

What else would be important for us to know about you?

The gender I identify most with is (male, female, transgender, etc.)? This question is optional.

Age? This question is optional.

Race? This question is optional.

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White

Ethnicity? This question is optional.

Hispanic/ Latino
Non-Hispanic/ Latino

Would you like to share anything else about your diversity with us? This question is optional.