2025 Application for the Virginia Individual and Family Support Program (IFSP) Western Regional Council

Nominee Information

DBHDS is pleased to announce that it is accepting self-nominations for the IFSP Western Regional Council! Please complete this form to nominate yourself for consideration on this 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. Please confirm that you live in the Western Region! This includes the following cities and counties: Albemarle, Alleghany, Amherst, Appomattox, Augusta, Bath, Bedford, Buena Vista, Campbell, Caroline, Charlottesville, Clarke, Covington, Culpeper, Fauquier, Fluvanna, Frederick, Fredericksburg, Greene, Harrisonburg, Highland, King George, Lexington, Louisa, Lynchburg, Madison, Nelson, Orange, Page, Rappahannock, Rockbridge, Rockingham, Shenandoah, Spotsylvania, Stafford, Staunton, Warren, Washington, Waynesboro, and Winchester.

You can also view our IFSP Regional Map.

Yes

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* 2. Contact Information

Name *

Address *

Address 2

City/Town *

ZIP/Postal Code *

Email Address *

Phone Number *

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

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

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* 5. Are you currently on Virginia's DD Waiver Waiting List?

Yes, I am on the DD Waiver Waiting List.

No, I am not on the DD Waiver Waiting List, but I receive Waiver services.

No, I am not on the DD Waiver Waiting List. I do not receive Waiver services.

Other (please specify)

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* 6. Are you a self-advocate (are you a person who has a developmental disability)?

Yes

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* 7. 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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* 8. Have you received IFSP-Funding in the past?

Yes

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* 9. Have you (or someone you know) attended an IFSP Regional Council-sponsored event or meeting in the past?

Yes