2025 Application for the Virginia Individual and Family Support Program (IFSP) State and Regional Councils

Nominee Information

DBHDS is pleased to announce that it is accepting self-nominations for the IFSP State and Regional Councils! Please complete the following form to nominate yourself for consideration for either the State or Regional Council.

Before applying, please review the State and Regional Council Descriptions, the IFSP State Plan, and IFSP Council Charter. Please visit the My Life, My Community website to review the documents.

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* 1. Contact Information

Name *

Address *

Address 2

City/Town *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 2. What are your pronouns? (e.g., she/her, he/him, they/them, she/they, he/they)

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* 3. Do you have a preferred title (e.g., Mrs./Mr./Mx., Dr., etc.)?

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* 4. Are you or your family member currently on Virginia's DD Waiver Waiting List?

Yes, I or my family member is on the DD Waiver Waiting List.

No, I am not on the DD Waiver Waiting List, but I or my family member receives Waiver services.

No, I or my family member is not on the DD Waiver Waiting List and does not receive Waiver services.

Other (please specify)

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* 5. Please check the boxes that best describe your circumstances.

I am a person with a developmental disability/self-advocate.

I am a family member and/or caregiver for someone with a developmental disability.

I am a professional who works with people with developmental disabilities.

None of these apply.

Other (please specify)

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* 6. Councilmembers serve as ambassadors for the IFSP, and share information about the program with their communities. Are you familiar with anything that the IFSP offers? Check all that apply.

The IFSP-Funding Program

The IFSP State Council and/or IFSP Regional Councils

Peer mentoring through The Arc of Virginia

Family mentoring through the Center for Family Involvement (CFI) at VCU

The My Life, My Community website and call center

I don't know anything about what the IFSP offers.

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* 7. Which council are you applying for?

State Council

Regional Council