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BIAA Education Task Force Volunteer Form
1.
Volunteer Contact Information
Name
Company
State/Province
Email Address
Phone Number
2.
Your connection to brain injury (check all that apply)
Psychologist
Medical Professional
Licensed Therapist
Social Worker
Administrator/Executive
Student
Family Member
Caregiver
Educator
Person with Brain Injury
Other (please specify)
3.
For professionals, how many years have you worked with persons with brain injury?
4.
Certifications/licenses held
5.
Previous committee or volunteer experience
6.
Why are you interested in serving on the BIAA Education Task Force?
