Nomination to National and / Regional Statutory Committees.

The survey will take seven minutes to complete.
This form must be filled out by the applicant nominee with the complete oversight and approval of their
line manager for the application.
Please review the DFI Representative Protocol in advance of completing this form.
If you have any queries contact Cathy McGrath - cathymcgrath@disability-federation.ie / 086 384 7440.

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* 1. Your name

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* 2. Insert the name of your nominating DFI member organisation. Please note ONLY fully paid up members of DFI can be selected for roles of representation.

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* 3. Your role

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* 4. Your email address:

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* 5. Your mobile number:

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* 6. What committee(s) are you submitting your name as potential representative to?

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* 7. Do you currently participate on any of the DFI National Advisory Committees? If so please note which ones you attend:

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* 8. Please describe any current / previous experience in committees / representation at local and / national levels.

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* 9. Please use this space to give an outline of your current role and relevant experience to bring to the Committee.

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* 10. Can you confirm that you are you in a position to carry out the roles and obligations as outlined in the Protocol for DFI Representatives, with the support of your organisation?

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* 11. Your nomination must be approved by your line manager to ensure your time is released and that the role as rep is approved.

Insert the name and full contact details for your line manager in the box below including mobile contact.

All nominations will be checked by DFI with member organisations.

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* 12. Thank you for your time, DFI values the role of our members in representing the wider membership at national level.
We are here to support you through this process, if you have any additional queries / clarifications please note them down here.
We will be in touch shortly.

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