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Application Cac19 (University of Wyoming)

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Page 1 of 4
WYOMING INSTITUTE FOR DISABILITIES (WIND)
CONSUMER ADVISORY COUNCIL
APPLICATION FOR MEMBERSHIP
T
he Wyoming Institute for Disabilities (WIND) at the University of Wyoming is seeking self-
advocates and family members of individuals with disabilities to serve as members on the WIND
Consumer Advisory Council (CAC). The members will assist the director of WIND to review
programs and to develop strategies to best reach and serve individuals with disabilities,
families, and professionals in Wyoming.
M
embers of the CAC are expected to:
• Attend two in-person meetings a year
• Participate in at least two teleconferences a year, scheduled as need
• Work on increasing advocacy within WIND
• Participate on WIND project advisory committees
• Share resources, ideas, and networks
• Represent WIND at local and regional events
W
IND will support members to participate in CAC meetings by:
• Reimbursing travel expenses for meetings
• Providing an accessible meeting space, materials, accommodations, and personal
assistants, as required, so all members can participate
• Creating an environment that encourages an opportunity to enhance leadership skills
• Sharing information about the activities of our partners in Wyoming
Future information about WIND and a current listing of our projects can be found on our
website at: www.uwyo.edu/wind
. We believe that consumer involvement is a great asset to our
work.
I
f you are interested in volunteering to improve the lives of individuals with disabilities by
serving on the WIND Consumer Advisory Council, please fill out this application and return to
WIND by E-mail, Fax, or mail:
Wyoming Institute for Disabilities
ATTN: Consumer Advisory Council
Dept. 4298, 1000 E. University Ave.
Laramie, WY 82071
Fax: (307) 766-2763
(307)
766
-2935| windcac@uwyo.edu
Page 2 of 4
Applicant Information
Name:
Address:
Home Telephone:
Cell Phone:
E-mail:
If you are employed, where do you work?:
I am a:
Person with a developmental disability
I am a family member of a person with a developmental disability
Parent
Sibling
Grandparent
Other________________________________________________
Tell us more about your disability or your family member’s a disability:
Why are you interested in serving on the Wyoming Institute for Disabilities Consumer
Advisory Council?
Page 3 of 4
Do you have any experience serving on a board, council, or other leadership
experience?
How can you best participate in the CAC? For example, what days and times work
best for meetings? What accommodations or training do you need? Do you need
child care or a support person to attend?
What else would be important for us to know about you?
Page 4 of 4
Optional Diversity Questions
These questions are optional. You can chose to answer these only if you would like to tell us
more about yourself.
The gender I identify most with is:
Male
Female
Transgender
Other________________
Age:
Race:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Ethnicity:
Hispanic / Latino
Non-Hispanic / Latino
Would you like to share anything else about your diversity with us?
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Completed 16 July 2020

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