Parent Advisory Council (PAC) Application

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* 1. Date

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* 2. Personal Information

Name

Address

Address 2

City/Town

State

ZIP

Country

Email Address

Phone Number

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* 3. Preferred method of contact

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* 4. Are you? (check all that apply)

parent with a disability

parent of a child with a disability under the age of 14

parent of a child with a disability over the age of 14

guardian

foster parent

family member

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* 5. Are you the parent or family member of a child or, foster child with a disability or special healthcare needs 0 to 26 years of age?

Yes

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* 6. What is your child's:

Age:

Disability:

School District:

School:

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* 7. Can you commit 2 to 3 hours per month to the Parent Advisory Council?

Yes

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* 8. b'Would you be interested in a virtual support group?'

Yes

Parent Advisory Council (PAC) Application

Question Title

* 1. Date

Question Title

* 2. Personal Information

Question Title

* 3. Preferred method of contact

Question Title

* 4. Are you? (check all that apply)

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* 5. Are you the parent or family member of a child or, foster child with a disability or special healthcare needs 0 to 26 years of age?

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* 6. What is your child's:

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* 7. Can you commit 2 to 3 hours per month to the Parent Advisory Council?

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* 8. b'Would you be interested in a virtual support group?'

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* 9. Tell us about yourself. What unique experiences, perspectives, talents, or skills could you bring to the council?

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* 10. Why do you want to be a member of the PAC?

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* 11. How do you define parent or family engagement?

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* 12. As a PAC member, what would you most like to learn about?