Become a Member

RI Statewide Independent Living Council

Committee Membership Application

Date: *

Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Phone

Highest form of Education: *

Please describe any additional training that you have had which may enrich or support the Council’s mission: *

Are you presently employed?YesNo

If yes, your duties in this job are:

Employer's Name:

What other employment or volunteer experiences have you had which might help enrich or support the Council’s mission:

Please comment on your availability: *

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Gubernatorial Appointment Application