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1. Date

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2. Personal Information

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3. Preferred method of contact

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4. Are you? (check all that apply)

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5. Are you the parent or family member of a child or, foster child with a disability or special healthcare needs 0 to 26 years of age?

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6. What is your child's:

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7. Can you commit 2 to 3 hours per month to the Parent Advisory Council?

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8. b'Would you be interested in a virtual support group?'

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9. Tell us about yourself. What unique experiences, perspectives, talents, or skills could you bring to the council?

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10. Why do you want to be a member of the PAC?

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11. How do you define parent or family engagement?

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12. As a PAC member, what would you most like to learn about?

T