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For consideration to a Washington State Independent Living Council (WASILC) Sub
Committee, please complete this form with your responses.

Commitment:
Serving on a committee requires a minimum commitment of 2 hours per month. If you are
unable to attend committee meetings or complete tasks, you are responsible for
communicating this information to the committee chairperson or the staff liaison.

Preferred Qualifications:
1. Knowledge, talents, expertise, experience, and energy to contribute to the committee.
2. Knowledge and experience of working as a team-member.
3. Specialty area knowledge, such as advocacy, housing, transportation, transition, education, employment, legal, fundraising,
finance, human services, specific disability, ADA, Fair Housing, etc.
4. Connection with other groups such as disability, business, civic, education or community groups.
5. Experience with independent living.
6. Willingness to commit to the responsibilities of committee membership.

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* 1. If you need any reasonable accommodations to complete this application or participate on this
committee, please contact us at 800.624.4105

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* 2. Information

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* 4. Why are you interested in serving on this committee?

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* 5. How will participating on this committee benefit you and/or your community?

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* 6. What knowledge, passion, and/or expertise will you bring to the committee?
a. If you have specialty area knowledge, as listed in preferred qualifications, please
include that information in your response.

You can write, record, or film your answers. (There is no length requirement.)

I agree to support and uphold the mission and policy(s) of the WASILC. I am committing to all of the
responsibilities and expectations described above. If I am unable to meet my obligations,
misrepresent WASILC or lobby while representing WASILC, I understand that I may be asked to
resign.

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* 7. Signature

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* 8. Date

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