2027 Application for the Virginia Individual and Family Support Program (IFSP) State and Regional Councils

Nominee Information

DBHDS is pleased to announce that it is accepting self-nominations for the IFSP State and Regional Councils! Please complete this form to nominate yourself for consideration on an IFSP State or Regional Council.

Before applying, please review the State Council position description, Regional Council position description, the IFSP State Plan, the IFSP State Council Charter, and the IFSP Regional Council Charter.

If you have any questions or need help, please email us: IFSPCommunity@dbhds.virginia.gov

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1. Which of the following statements best describe you? Please choose all that fit. (Required.)

Person with a disability or self-advocate – I identify as a person with a developmental disability.

Family member – I am a parent, sibling, or other family member of a person with a developmental disability.

Caregiver – I help someone with a developmental disability.

Professional – I work in disability services, education, healthcare, or another related field.

Community member – I am connected to disability in another way.

Other (Please describe)

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2. Do any of these describe your situation? Please choose all that fit. (Required.)

I am on the DD Waivers Waitlist – I am waiting for DD Waiver services.

I have a DD Waiver – I get DD Waiver services now.

I support someone on the Waitlist – A family member or person I support is on the Waitlist.

I support someone who has a DD Waiver – A family member or person I support gets DD Waiver services.

I have experience with the Waitlist through my work or community role – Please describe.

None of these – I do not have experience with the DD Waiver or Waitlist.

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3. Which IFSP Region are you applying for?

You must live in the region for the Council you wish to join.

IFSP State Council members also serve on their IFSP Regional Councils.

(Required.)

Western Region (Region 1): Albemarle, Alleghany, Amherst, Appomattox, Augusta, Bath, Bedford, Buena Vista, Campbell, Caroline, Charlottesville, Clarke, Covington, Culpeper, Fauquier, Fluvanna, Frederick, Fredericksburg, Greene, Harrisonburg, Highland, King George, Lexington, Louisa, Lynchburg, Madison, Nelson, Orange, Page, Rappahannock, Rockbridge, Rockingham, Shenandoah, Spotsylvania, Stafford, Staunton, Warren, Washington, Waynesboro, and Winchester

Northern (Region 2): Alexandria, Arlington, Fairfax, Falls Church, Loudoun, Manassas, Manassas Park, and Prince William

Southwestern (Region 3): Bland, Botetourt, Bristol, Buchanan, Brunswick, Carroll, Craig, Danville, Dickenson, Floyd, Franklin, Galax, Giles, Grayson, Halifax, Henry, Lee, Martinsville, Mecklenburg, Montgomery, Norton, Patrick, Pittsylvania, Pulaski, Radford, Roanoke, Russell, Salem, Scott, Smyth, Tazewell, Wise, and Wythe

Central (Region 4): Amelia, Buckingham, Charles City, Charlotte, Chesterfield, Colonial Heights, Cumberland, Dinwiddie, Emporia, Goochland, Greensville, Hanover, Henrico, Hopewell, Lunenberg, New Kent, Nottoway, Petersburg, Powhatan, Richmond City, Prince Edward, Prince George, Surry, and Sussex

Eastern (Region 5): Accomack, Chesapeake, Essex, Gloucester, Hampton, Isle of Wight, James City, King and Queen, King William, Lancaster, Mathews, Middlesex, Newport News, Norfolk, Northampton, Northumberland, Poquoson, Portsmouth, Richmond County, Southampton, Suffolk, Virginia Beach, Westmoreland, Williamsburg, and York

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4. Name (Required.)

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5. Address (Required.)

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6. Your email address (please use a reliable email address that you check regularly!) (Required.)

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7. Your phone number (Required.)

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8. What are your pronouns? (For example: she/her, he/him, they/them, she/they, he/they)

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9. IFSP Councilmembers serve as ambassadors for the IFSP, and share information about the program with their communities. Are you familiar with any of the IFSP resources below? Check all that apply. (Required.)

The IFSP-Funding Program

The IFSP State Council and/or IFSP Regional Councils

Peer mentoring through The Arc of Virginia

Family mentoring through the Center for Family Involvement (CFI) at VCU

The My Life, My Community website and call center

I don't know anything about the IFSP.

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10. Which IFSP Council are you applying for? (Required.)

The IFSP State Council (read the State Council member description)

The IFSP Regional Council (read the Regional Council member description)

2027 Application for the Virginia Individual and Family Support Program (IFSP) State and Regional Councils

Nominee Information

Question Title

* 1. Which of the following statements best describe you? Please choose all that fit. (Required.)

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* 2. Do any of these describe your situation? Please choose all that fit. (Required.)

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* 3. Which IFSP Region are you applying for? You must live in the region for the Council you wish to join. IFSP State Council members also serve on their IFSP Regional Councils. (Required.)

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* 4. Name (Required.)

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* 5. Address (Required.)

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* 6. Your email address (please use a reliable email address that you check regularly!) (Required.)

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* 7. Your phone number (Required.)

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* 8. What are your pronouns? (For example: she/her, he/him, they/them, she/they, he/they)

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* 9. IFSP Councilmembers serve as ambassadors for the IFSP, and share information about the program with their communities. Are you familiar with any of the IFSP resources below? Check all that apply. (Required.)

Question Title

* 10. Which IFSP Council are you applying for? (Required.)

1. Which of the following statements best describe you? Please choose all that fit. (Required.)

2. Do any of these describe your situation? Please choose all that fit. (Required.)

3. Which IFSP Region are you applying for?

You must live in the region for the Council you wish to join.

IFSP State Council members also serve on their IFSP Regional Councils.

(Required.)

4. Name (Required.)

5. Address (Required.)

6. Your email address (please use a reliable email address that you check regularly!) (Required.)

7. Your phone number (Required.)

8. What are your pronouns? (For example: she/her, he/him, they/them, she/they, he/they)

9. IFSP Councilmembers serve as ambassadors for the IFSP, and share information about the program with their communities. Are you familiar with any of the IFSP resources below? Check all that apply. (Required.)

10. Which IFSP Council are you applying for? (Required.)