Partners in Policymaking Application for 2020

Partners in Policymaking is a leadership training program for adults with disabilities and parents of children with developmental disabilities.  The program teaches leadership skills and techniques to develop positive partnerships with elected officials, school personnel and other individuals who make policy decisions about services that you and/or your family use.

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* 1. Name and Contact Information

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* 2. What is your age?

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* 3. Are you a person with a developmental disability? If yes, please describe your disability/ies below.

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* 4. If you answered "Yes" to Question #3, do you have a guardian? If yes, please enter their name and contact information in the box provided below.

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* 5. Are you a parent of a son/daughter who has a developmental disability? If you are NOT a parent, please skip to Question # 11.

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* 6. If you answered "Yes" to Question #5, please briefly describe the disability and how it affects the ability to function in at least three areas of major life activity. (speech, mobility, social skills)

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* 7. If you are a parent, please briefly describe your child's school placement.

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* 8. If you are a parent, does your son or daughter live at home?

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* 9. If you are a parent, do you have other children?

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* 10. If you answered yes to question # 9, please list how many children and their ages below.

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* 11. Are you a sibling or other family member that is the primary support of an individual? If yes, please briefly describe in the comment box below.

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* 12. What services are you or your child currently receiving (i.e., First Steps, School, Respite Care, Support Coordination, Employment, Housing, Attendant, etc.)?

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* 13. Why are you interested in the program? Is there a specific issue, area of concern, or problem that encourages you to apply? Please give a brief explanation below.

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* 14. If selected to participate in the Partners in Policymaking Training Program, I agree to the following in order to successfully complete and graduate from the program.
1. Travel to Jefferson City/Columbia to attend the regularly scheduled meetings. (Reimbursement for mileage would be available).
2. Make a commitment to attend eight, two day sessions (Friday: Noon - 9:00 pm, Saturday: 7:30 am - 3:30 pm), held monthly from February 2020 - September 2020.
3. Complete all homework assignments (approximately two hours per month).
4. Complete one major project (i.e., a letter writing campaign, organizing a town meeting). Major projects are decided upon by Partners Coordinator and myself, depending upon my interests and competency needs.
Meeting dates for 2020 (Friday and Saturday) are: February 7-8, March 6-7, April 3-4, May 1-2, June 5-6, July 10-11, August 7-8, September 11-12.


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* 15. What types of experience, if any, have you had in advocating for people with intellectual and developmental disabilities? (Provide examples to include membership in an advocacy organization, etc.).

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* 16. Please tell us a little about yourself and your family and why you think you would be a good candidate for this program. For example; what do you hope to gain from this experience? What will you bring to the experience?

IMPORTANT NOTE: the advisory committee will place significant emphasis on the responses to this question.

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* 17. Race/Ethnic Background (Optional)

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* 18. Please list your gender (Optional)

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* 19. Please list two references including name, address and phone number.

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* 20. How did you learn about the Partners in Policymaking Program?

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