Disability Health Advisory Panel - Application for Membership

The information you submit in this survey will be used by staff to evaluate candidates' applications for advisory panel membership. Aggregate summary data for all those who respond may be reported publicly. Because of the historically small size of HERC’s advisory panel applicant pools, it may be possible to identify how individual applicants have answered the survey from this aggregate information.

While you are not required to answer any questions about personal identities, we encourage you to share any information you are comfortable sharing to aid in our efforts to improve representation, with the understanding that this information may be disclosed (with personal information redacted according to the law) in the event of a public records request.

If you require additional information about the confidentiality of this information, please email us at herc.info@OHA.oregon.gov so we can address any questions before you fill out the survey.

Please be sure to complete the entire survey and click "Submit Application" on the third page.